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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 a. NUI`f-hEFUNUABLE t'ERMIT GALL (ZU9) 993-/69/ FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS 3735 E 8i4jL(ZOrJ RD _ CITY/ZIP AGA*-1Re /9522-0 CROSS STREET fTTVV/ APN L'X&'7/6 0 _1!�7 PARCEL SIZE OWNER NAME S=Ar%B�1'13W6FkWW► I�PHONE OWNER ADDRESS�/k"v __CITY/STATE2IP CONTRACTORSS LDMST(LGT Q)►Yl I 9�Z7 SJ Q CONTRACTOR ADDRESS 70 BOIL t L/ y /� CITY/STATE21P C/ k G7� ,ea4 69, S S-) S/ LICENSE J�'' C-42 ❑ i C-36 OTHER NUMBER 970q 1 3 6/ EXPIRATION DATE 9/2019 ' WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y 1_1 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION / REPAIR/ADDITION ENGINEER DESIGNED REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: -r-T RESIDENCE J COMMERCIAL :747 I 1 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: '✓j NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP TERNATIVE CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS ft FOUNDATION - _ It PROPERTY LINE ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) N( LEACH LINES LEACHING CHAMBERS I '' Received B # OF LINES LENGTH OF LINES ss ft Permit/ I Service Request # DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH - ft DEPTH AYMT RAIIt DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LIN "Ti� ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL _ ft FOUNDATION _ ft PROPERTY LItj 2njft ❑ SUMPS WIDTH ft LENGTH _ ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LL1J, AQUfN CO ft ❑ DISPOSAL PONDS WIDTH ft LENGTH _ ft DEPTH HEALTH NTAL ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE rvlttvT ft SEEPAGE I e 2 S' PITS NUMBER WIDTH-------- -_ ft DEPTH It DISTANCE TO NEAREST WELL _ _.. ft FOUNDATION ft PROPERTY LINE It I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. SIGNED Application Accept Final Inspection 6 Character of Soil to COMMENTS ' VANCE NOTICE REQUIRED FOR INSPECTIONS - TITLE (A /A,) ^R DATE 2 . 2 $• 17 DEPARTMEN U S._ff O Y ll Date_ Area Employee ID#V IF Date ❑ SPECIAL ERMIT - Approved by of 3 Ft: Pit/Sump Soil Character: PE Code SC INFO Received B a Amount i Cash Remitted Date I Permit/ I Service Request # Invoice # Permit ID# 0 t 3 -314111 EP -00 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12 r