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L + <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-KEFUNDABLE PERMIT GALL LUY &0J -10a/ FORINSPECTIONS tXPIRES l YEAR FROM DATE ISSUEI <br />JOBADDRESS 4j[; CITY/ZIP S-TCi��Crj, gf52U <br />CROSSSTREET 1 UV OUE APN I�--%I PARCELSQE 0 <br />Tf <br />OWNER NAME . 1 LOS LyL\ 0) E'I'1r707—A C PHONE 1 <br />OWNER ADDRESSS / ��I F. ux-ew D-. y- CITYISTATE/ZIP--�It�L!(.'(pnJ Ing / �/ 5712 <br />CONTRACTOR j -S t'O.il$ll'c. u.�-�77n1 .S EPTi-L, 1(qJ(, PHONE SII iY - 22c]-'— '-i S <br />I % / <br />CONTRACTOR ADDRESS uS-77 M eCe n vy CfL�+( DR u- 20Q CITYISTATEIZIP. i." w,.r^s�y'rp C/9 / 1$ s'L Q <br />T <br />LICENSE C42 �C-36 OTHER NUMBER jZ2y3l,. EXPIRATION DATE L./ S`'1 / �L-Z2.. f <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # <br />BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLAnoN <br />REPAIRIADDITION <br />ENGINEER DESIGNED IALTERNATNE <br />WIDTH <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />j <br />DESTRUCTION +rL Y"4j!D I <br />INSTALLATION WILL SERVE: RESIDENCE <br />COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: Z <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASETRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />H FOUNDATION <br />DISTANCE TO NEAREST: WELL <br />R FOUNDATION <br />R PROPERTY LINE fl <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />`'r ')1 <br />DISTANCE To NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />It LENGTH <br />ft DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />It DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />H FOUNDATION <br />ft PROPERTY LINE It <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />It DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />R FOUNDATION <br />ft PROPERTY LINE It <br />❑ DISPOSAL PONDS WIDTH <br />R LENGTH <br />It DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />R FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH R <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT <br />I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />DEPARTMEN T7.US6 ONLY <br />Appllcatlon Accepted By r—�</ �� Date ,) 0, 7 Area (bel Employee IDN DA <br />Final Inspection By A Date SPECIAL PERMIT -Approved by <br />Character of Soll toDepthof 3 Ft: Olt/Sum <br />'S0 <br />o11 Character: <br />/ <br />COMMENTS (_'o.T11CL 11/u t,-*.P-ed�rL'�ellc 5r^IPri 9r:',k )1y!Fc' <br />LT 4' e-4--4r­j'r,JOr'r e -t•+; Il1 r f -fie +n /�/� -! � <br />PE <br />Code <br />SC Received <br />INFO <br />Amount Date PermiU Involce# <br />ash Remitted Service Request <br />PermltID# <br />`'r ')1 <br />075 I <br />I L11041 I V5,? lid Lt, <br />hoed <br />MENT <br />EIVED <br />Q 6 20210, <br />UIN COUNTY <br />)NMENTAL <br />EPARTMENT <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 <br />