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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 t:ALL (ZU,9) ybJ-/bYf FOR INSPECTIONS tXPIRES l YEAR FROM UATE ISSUEI JOB ADDRESS 3413 E. SECTION AVENUE CITY/ZIP STOCKTON CA 95205 CROSS STREET S. GOLDEN GATE AVENUE APN 173-090-32 PARCEL SIZE 0.27 OWNER NAME/.f�z��fifs l.� pe,Is�,�i�q e � PHONE 479-670-1658 OWNER ADDRESS 3733 SECTION A'VYE,NUE�f" Z j ,��,�y��ITY/STATE/ZIP STOCKTON CA 955215 CONTRACTOR TERRACON CONSULTANTS (NEIL O. ANDERSON & ASSOCIATES) PHONE 209-367-3701 CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI, CA 95240 LICENSE C-42 C-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5/31/19 WATER TABLE DEPTH: 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 -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY ❑ GREASE TRAP TYPE/MFG CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION _ ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS Received By Check#/ Cash # OF LINES Invoice # LENGTH OF LINES uz DISTANCE TO NEAREST WELL a;� a 5 z 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, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ft ft ft ft ft ft ft ft ft ft ft ft ft -Sa61:1JL11..��..i�...7-7i.t77.. �1•'lL...-. iI M.y..O1A1�111ar�I-13 n,-��7�.�7Ll L��i'�r�<•i' SC INFO Received By Check#/ Cash Amount Date Permit/ Remitted Service Request # Invoice # Permit ID# uz ! a;� a 5 z ! d' s �-� 1411 PE Code SC INFO Received By Check#/ Cash Amount Date Permit/ Remitted Service Request # Invoice # Permit ID# uz ! a;� a 5 z ! d' s �-� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18