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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209) 468.3420 NUN-MEFUNDABBLE PERMIT r �,pUALaL ((ZUU,V) VOJ--[bV [ FOR INSPECTIONS tXPIRESQ"I YEAR FROM DATE ISSUE JOB ADDRESS 2 �- 9 4 J- S • c1 - r'-) 9 / ' ' �l� 1—Z/ . CITY/ZIP 1 r-7 "y ' 1304 CROSS STREET `L-INNG [APPN �\�S - 0&O - O4 PARCEL SIZE t� A- OWNERNAME WDOI INC. (b?,NAJ-1 O�-MC I Ei1Cb) ..-�{PHH.NNE-h1.51 OWNER ADDRESS �� C) ViI `��S 1 CITY/STATE/ZIP 1 1' TT �`'-� C� A + rJ CONTRACTOR L N E- 1U f�1L C�£DCyN�V l Y1 7.)CL_ PHONE ,3y) - oil 1 ] G� CONTRACTOR ADDRESS -4O'} A) . OAle- ST. CITYISTATEIZIP �D1 1SZ+o LICENSE IC -42 C-36 OTHER NUMBER EXPIRATION WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y X PERC TEST # Z FBUILDING PERMIT # LAND USE APPLICATION # -) cr' f 7 - TYPE OF WORK: I_I NEW INSTALLATION I REPAIR/ADDITION El ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT II DESTRUCTION INSTALLATION WILL SERVE: LI RESIDENCE I I COMMERCIAL l OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft 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 ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ 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 I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 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. MINIMug;,2 i0UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED I ` TITLE �NsV(—TYT DATE 248-080-03 248-860-09 / LOr 57 JOHN MENDOZA AND MARIA MUGIA EDDY R. AND /• PROPOSED 25 -FOOT MODE PRIVATE INGRESS/EGRESS I�I AAACEU RLYESQ AND UnUrY EASEMENT ACROSS PARCEL '2' FOR II Oa. THE BENEFIT OF PARCEL '1' NaW55'30'W 1042.01' II 370.43' _ 641.58'_ _ __ -- ------ EjT UN 2N U`��G�� M1w9 LOM. S P. I50g 1/J R "`- PERF00T WIDE BCOR' EASEMENT ,%/� PARCEL "1" Z oma 2.50 ACRES PARCEL "7" 7:7 N89.55130W 339.31' N b 2.50 ACRES / W04'3WE 248-080-05 95.00' JOSE LOPEZ / 619.68' 302.27' N59'55130'W 921.95' / 16' LOT 59 LOT UNE �% 240 -080 -OB EUFEUA GRIVOWS 47 d0 r DEPARTMENT USE ONLY �( �) ^ Application Accepte By Date /_ / 21 I eO ( /r/ Area Employee ID# ... N rt S ✓/ 1 Final Inspection By Date_71tal"lf _i SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft*Pftump Soil Character: COMMENTS -�0�� U PE SC Received heck#/ Amount Date Permit/ Invoice # Code INFO Remitted Service Request # Permit ID# 14, L V -21-R -)K 0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT