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L <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUN'Tl'ENVIRONMENTAL HEALTH DEPARTMEV'T 304 E:WEBER AVE-3"DFL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE <br /> �PERMIT <br /> ' f n,- IT CALL <br /> 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 130O KM CSI�7Q�1 NIVE CITY/ZIP T?," 95SI Iy <br /> I <br /> CROSS SI'REET ouwsll1l, "-se C't� APN Z0'1- 60—11 PARCEL SILL-ab <br /> _T[ o <br /> OWNER NAME TVSOL{ I..NI�-I�,.L�GS�J� EM�ARILyrl pP�HO,NE: <br /> OWNERADDRESS 1� �'' " t�`�'� CITY/STATE/ZIP <br /> CONTRACTOR - ASSvC PHONE <br /> CONTRACTOR ADDRESS CITYISTATE/•LIP <br /> LICENSE O C42 O C-36 OTHER - NUMBER '�-u�'L3j t7 EXPIRATION DATE 'f l IQ ly <br /> WATER TABLE DEPTH: I 1l GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIMN(:UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPF/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMF(i CAPACITY gal #OFCOMPARTMENTS_, <br /> ❑ PKG TX PLANT DISTANCETONEAREST: WELL R FOUNDATION <br /> O emE <br /> R <br /> LIFT STATION SIZE TYPE OF PUMP P,-D �EP A � Y <br /> 13 LEACH LINES El LEACHING CHAMBERS #OF G efff)it M yhave*atl <br /> withoutft <br /> DISTANCE TON£AREST WELL ft FOUNDATI(VVGfl( fI MptelP1 ll�tfl'Ik� pQ,C:tP,IJ,.1 R <br /> ❑ FILTER BED WIDTH ft LENGTH l 1E11,I 11....1}[,PjV; •:nn it <br /> 1 DISTANCE TO NEAREST WELL ft FOUNDATION 'E ironiWI •�LPROPERTYrLINE I <br /> ❑ MOUNDED WIDTH_ft LENGTH ft DEPTH _ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft \ <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> U DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH it <br /> I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME fl <br /> I ❑ SEEPAGE PITS NUMBER WIDTH Il DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CF:RTIFV THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDAN'C£WITH SAN JOAQVIN COUNTY <br /> ORDINANCES,STATE:LAWS AND RULES AND REGULATIONS OFSAN JOAQUIN COUNTY. <br /> MINI M 24 HOUR ADV <br /> LANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL <br /> /(299)953-7697 <br /> SIGNED y✓ �i/Zl TITLE d /t W7-DATE <br /> 1 <br /> 11, <br /> IIE:6258708.047 <br /> TiA T2 r I <br /> T. T3 (P=771.60' C16,3 <br /> .7T <br /> I »6 R=171.61'11.5725 C1 <br /> 53 7✓'/BNOt 1 <br /> 15 CL. C 19 P.M. 34, <br /> 4 (P=91.BJ'1-01.189 <br /> -91.09' 11-82"35'00r L-131. a <br /> PCL. A I i. <br /> �?J. � <br /> C;1-. ^ 14M4'14'w 710.00'ANDY N <br /> A MEN I <br /> ` - ..• I(709.95) <br /> i'i;RCEL 1 A rs �s <br /> 15 BMT }�. <br /> L LA- NBJ24'I w 706.90' BWY S. Y <br /> {`!W 97-53 ( BS) 16 FD. <br /> MATTHEWLA..NDS INC I R.E. 6 H H E <br /> T\C J Ic (161169) D.N. 2004-•214591 (761 <br /> 4�89'10'18'W 2644.88 SES. COR. T01tC R. N89'09'03'W 264 <br /> f I r <br /> PARCEL PES ASUS- <br /> _ 26.652 Y AC MATTHEWS LANDS INC I <br /> $ D.N 2004-214 59 1 I� VELA rURcS <br /> DOCUMENT � <br /> Application Accepted By Date O Area - Employee IDN (� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Chaneter of Soil to Depth 3 FY: _ Pit/Sump So ll C ratter. <br /> COMMENTS <br /> i <br /> PE SCReceived Chec W1J Amount DOEPermit/ lnvolce# Permit[D# <br /> Code INFO By as Remitted Service Re uest# <br /> 4077, Cz N C1 13,00 \b1A 0 'koo �- <br /> 001 / <br /> 42-02-001 ♦^���-/w`D \ ONSITE WASTEWATER PERMIT <br /> 12/222003 <br />