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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E:WEBER AVE-3""FL-STOCKTON CA 95202 -(209)469-3420 NON-REFUNDABLE PERMIT ',a IT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS 1-1��V kL 60_0431 WNIC CITY/ZIP a" •�� N CROSS SI-It ' HOUR.T-NA 1--56 l--I� APN 7-01-Nob-fl PARCEL SIZE o OWNER NAME TuSrfO l..M��S�J,� 1Ms}\�{(�C�Y� pPIHIO�NE OWNERADDRESS IZ_�2.`I`1 �'' " 1�` t"V CITYfSTATE/ZIP CONTRACTOR YV �SSVG. PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE 0C-42 ❑C-36 OTHER - NUMBER L) EXPIRATION DATE 11 I WATER TABLE.DEPTH: }1 ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # / - BUILDING PERMIT N LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESICNEDIALTERNATIVE' ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER _ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: INumeEROF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG ,_-_ _._ _-_-- CAPACITY gal #OF COMPARTMENTS__... ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION_ _TRft OP NE ft ❑ LIFT STATION SIZE TYPE OF PUMP r��'-WEP�� E Y T 1) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF1Lopertnit may y.(1am�6tQl?;f pad withoUl 0 DISTANCE TO NEAREST WELL ft FOUNDATICV4rr1P1Ci`T��Yt1CnP.ftP.f� n ❑ FILTER BED WIDTH ft LENGTH t DEPT}l,I 11 �; L E1T ,nn R e DISTANCE TO NEAREST WELL ft FOUNDATION -I. irorIIL. LQR.PERT.i'Lh I��ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH — ft DISTANCL TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R U DISPOSAL PONDS WIDTH ft LrNGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LNE A I ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH_ ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. j MINI M 24 HOUR ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL((2299)/)9953-7697 I SIGNED ---.A✓ �r/Lf^� TITLE S/ EN[�'�`.DATE N. 94 z _ E: 625870&047 t:`fib T2 r T3 R-771,60' I-165.77" R=171.61'Ay5721O(T L=165.131'BHDY _S? T16 I I:. - il5 PCL. C 19 P.M. 84, s ` 4 (R=91.6J't=131.16') I IS'. .,••`t' -91.D9' &-W35i00r L-131.29' PCL. 5 FCL A l� �^l �, f rJ, I•� N 4Y24'1 4'W 710.00' 6NDi I(709.95) `S 1.656 3 AC w 15L�''AM�7 C 78 VL 7 LA- NtiY24'I W 708. BNOY S. Y (70B 85 95) • q^ 97-53 16 FO. MA TTHEWS LANDS INC R.E. 6 HEALrH DEPAFTM 1 89'lo'I �16K•69f D.N. 200,4-214591 (,?644 �t 26444..8888 SEC. COR.ROS 4 C R.. N89'09'03'W 264, PARCEL I PEGASUS- _ 26.632 S AC NWTTHEW5 LANDS INC 1 D.N. 2004-2I4s91 I� VEN-rUREE i" DOCUMEIIN f _ Application Accepted By T Date Area Employee ID# (� � Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth 3 Ft: Pit/Sump 5011 C reeler: COMMENTS (� p s PE SC ReceivedCheck#/ Amount Date Permit/ Invoice# Permit ID# Code INFO By as Remitted Service Request# L zt �3,oo s" \0 3u ";PCO 0o`i9 42-02-001 (..mss y Cl D ONSITE WASTEWATER PERMIT I2122f2D03 �. J -