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i ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209) 466-3420 NON-KEFUNDABLE S PERMIT [' k ALL ILU`J VOJ-/Oyt / FOR INSPECTIONS XPIRED 5 l TEAR FROM ATE ISSUEI JOB ADDRESS HV�rKw . M 0 (3 LEY '- b • I p CITY/ZIP ? 1 Ki1�•� CROSS STREET Srpw LE y APN - o � -D 170 -1 � PARCEL SIZE 31-grJ� OWNER NAME EYti i �y rnrL-ry pPHONE—R?,� 3 -1-f d OWNER ADDRESS Z2�%'� N� 0000\) P-6 It 7- CITY/STATE21P MAWFCT I. GH RS336 CONTRACTOR "Jt D(W-Geo ENV122�n�n'1E/v PHONE 3(p ( -03-+s- ,, p, q�• CONTRACTOR ADDRESS 40� w • 0 &� S•�-' CITYISTATEIZIP Lz al C- ! l 5] Z4z) LICENSE IC -42 iC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # 3 1 BUILDING PERMIT # qPM LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION II ENGINEER DESIGNED /ALTERNATIVE 'wDI yZ REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: : RESIDENCE .. COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SUMPS ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS NUMBER WIDTH It DEPTH _ It DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE _ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES It qPM DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Ear ��; L3FILTER BED WIDTH ft LENGTH ft DEPTH It 'wDI yZ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH Y O DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft /� ?O,j{ VV ❑ SUMPS WIDTH ft LENGTH ft DEPTH 4U/N DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE kL-2 _ ❑ ft ft DEPTH M CO DISPOSAL PONDS WIDTH LENGTH DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft Fp�TTA�� MfNT ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH _ It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft 1 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. � I IMUM UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE N iV L-r.7'f DATE MOBLEY ROAD I' x rp. I it cc IX tlRr mr I I oai pp.0 a rwp '�� I tlp- pow rR r rm a> IX � PARCEL 2 1112* ACRES N 1073 ACRES an vwrtx�� I � aatss� [w�¢um anvt 'w• — �sc ,�a tlra � ee �-A- P- � . r I R , rx �III I __J i"�" pa3p pRp n I L_ J � PARCEL � a tlm1 o N 3 a onr lOeF ACRES I RwD P III , IX tllGl I ;�{//' x p.p a OWI ppb I R qRI ROID DEPARTMENT USE ONLY�/ 1. I S- �! Application Accepted By74L-Date Area Employee ID# Final Inspection By Date r/20 /it SPECIAL PERMIT -Approved by Character of Soil Sp ept of 3 t: Pit/Sump Soil Character: COMMENTS YL Z A, AAAI All PE SC Received Amount Date Permit/ Invoice # Permit ID# U W Code INFO B Cash, Remitted Service Re uest# 4 as 2 .53 S -7/lb O 0 42 01 y -1 , i 6 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 71PYC L • b 0