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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-KEFUNDABLE PERMIT GALL ZU'J Y03-/bYI FOR INSPECTIONS LXPIRES l YEAR/FROM UATE ISSUEI JOB ADDRESS f %GYRO `, `/� / 5R 12 O /� p CITY/ZIP 1l /C LENGTH OF LINES gaaa sa3 CROSS STREET /y%L(Rf Y RD - APN �4S r (iTpO- 3 y PARCEL SIZE 141.// OWNER NAME THE W,fj Gaouto ❑ FILTER BED PHONE ft OWNER ADDRESS 14 3(o'—, - A710 CITY/STATE/ZIP !Z� ^ ?5 f/p 6 CONTRACTOR C'ONS941- PHONE a©� 0 Z -'///-A ft CONTRACTOR ADDRESS CITY/STATE/ZIP 1,RLill, Ic C/Q gS-3�J ft LENGTH LICENSE ❑ l C-42 ❑IC36 OTHER (�� NUMBER EXPIRATION DATE (fes A0 DISTANCE TO NEAREST WELL WA R TABLE DEPTH: 319 ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK ❑ GREASETRAP TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES I I LEACHING CHAMBERS heck#/ Amount Remitted # of LINES Permit/ Service Request # LENGTH OF LINES gaaa sa3 DISTANCE TO NEAREST WELL 1(:10g-i12,71i ft FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SUMPS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, ft ft ft ft ft ft ft ft ft ft ft ft DEPARTMENT USE ONLY Application Accepted �� Date /,/,?72 Area y / Employee ID# A Ll Final Inspection By Date �11-31U ❑ SPECIAL PERMIT -Approved by Character of Soil to I �th of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Code INFO Received B heck#/ Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# gaaa sa3 °I 1(:10g-i12,71i 019 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18