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"A"I Ln I r[CF►I IYICIV 1 -")T,)I Cm IJLKMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 <br /> NON-REFUNDABLE PERMIT 1,pCALL 209 953-7697 FOR INSPECTIONS �p��EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2-T- 4T� Ci1 1 f--I,��I/�T�J (2D CITY21P_ -T7-,kr-1q�r-1q 9! 3-30 L - r_n <br /> CROSS STREET -�7 <br /> APN /- +S 194 PARCEL SIZE Ate.• O <br /> OWNERNAME IQDO /NC-. (br1rNN\I 0LMO-rFkb\ <br /> • _ �� ' ) PHONE 30&--1 9 <br /> OWNERADDRESS 13�TES T. 6C <br /> o <br /> CITY/STATE/ZIP _ Cy, CA q�--g0 <br /> CONTRACTORLME UfCK- C7 EDF Vt( 0r'jMe?'-7'.Pr PHONE ._.31o`7'03� <br /> CONTRACTOR ADDRESS -4C)--1- (fit.,). to/-`�L ? ( .. CITY/STATE21P "DI{ CA ctsi+ <br /> LICENSE OC-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> ��rr PERC TEST # Z Y <br /> Y� � BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: 0 NEW INSTALLATION ❑ REPAIR/ADDITION <br /> ❑ REPLACEMENT ❑ DESTRUCTION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY <br /> ❑ GREASE TRAP TYPE/MFG gal #OF COMPARTMENTS <br /> CAPACITY gal *OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ LIFTSTATION SIZEft <br /> TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES <br /> LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH <br /> ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE To NEAREST WELL ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH <br /> ft DEPTH � j <br /> WELL <br /> DISTANCE TO NEAREST ft FOUNDATION ft PROPERTY LINE ® -V <br /> E3ft <br /> DISPOSALPONDS WIDTH0O <br /> LENGTH ft DEPTH � <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE j <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH Vr� �Q Q <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> • ft PROPERTY LINE ft ..i Q; <br /> IH <br /> EREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, Zty <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED MINIMU��UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> TITLE C01`lSVLTYYltf'f DATE 5 <br /> 268-080-03 <br /> 248-6GO-09 s0 j LOT 57 JOHN MENDOZA AND MARIA MUGA <br /> CODY ACEU REYES R.AND <br /> AFAC �y PROPOSED 25-FOOWI <br /> T DE PRIVATE INGRESS/EGRESS III 30'130' <br /> y `�• AND UTILITY EASEMENT ACROSS PARCEL'2'FOR II <br /> THE BENEFIT DF PARCEL'1' I�1 <br /> N89 55'30Y1 1042.01' I <br /> S- 370.43' 841.56' <br /> 26C! h9 LOT UNE <br /> A <br /> MI.Gz P. !0-!!J N 10-FOOT WIDE SCID FASEIADdT <br /> P/ LOT 5B PER O.R 733-111 <br /> PARCEL "1" <br /> /��g"�� 2.`50 ACRES R PARCEL »L" ,�/ N8W59'3O-W 339.31' I� <br /> 2S0 ACRES N00'04'30-E 248-080-05 <br /> 95.00' JOSE LOPEZ (A( <br /> 619.08' 302.27' yC <br /> N89'55'30'W 921.95' 1 <br /> LOT 59 LOT UNE ,i I <br /> V <br /> 248-080-06 // <br /> EUFELIA GRANADOS 4/ 30'130' <br /> DEPARTMENT USE ONLY �j /v/] <br /> Application Accepted By Date /�� �TO�D -�1 ----� � J SCO <br /> b, Area Employee ID# <br /> Final Inspection By Date EDSPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: <br /> Pit/Sump Soil Character. <br /> COMMENTSc S > <br /> • PE SC Received heck#/ Amount <br /> Code INFO Date Permit/ <br /> l�z <br /> Remitted Service Request# Invoice# Permit ID#q_ZI-1 Qi, T <br /> 42-01 <br /> �•�' ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />