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ONSITE WAS*EWATER TREATMENT SYS').E:M PERml SCANN`�ifC SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT c CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED G ,/ JOB ADDRESS / /- iu CITY/ZIP A�SGAI—OAI 95320 y CROSSSTREET WA!an/ER APN Yos'070 4,57,0f`� PARCEL SIZE / / AL o OWNER NAME Inn • moN7y d4AID,-R 5AEK PHONE 930- 01,44 OWNER ADDRESS 10-417 GGT*ST tV �f E- CITY/STATE/ZIP Gs C.4 L'dpN CONTRACTOR G�4L Al CPlvjmcfi/J PHONE CONTRACTOR ADDRESS r, B • Ho CITY/STATE/ZIP CC/Z4-49C—k, LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE WA ER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: O(1 ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LME R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME R ❑ FILTER BED WIDTH ft LENGTH. R DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH R DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R 1 HEREBY CERTIF THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY O ANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. INT ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 -7 SIGNED TITLE ��✓W� DATE /—f3—OS 14 ax N �rnLJ III �1� � SU m n �v�z �.i arno`d in No �N20' 0 500'57'26"E S005126"E 130553 PARCL "1" � 1297 ACE5 4uv j wm�2 o5NmNmg'` v o _ '26"E 130522't500'51 > op ma �v\ I sA y A ai NIj <mM NPARCEL "Z' 01, 1z.61 7 uACRES ZC M ? n9 m�iil "II S0057'26"E 1304.90' �- '-rnv rs' s.{ .,. u PARCEL "3" - �.II N r u 1293 ACRES I ITV I 1193.57 1304,55' 'T 500 SPa9"E�� Za96.22' /} .1 ;tivPAR1'4FNT'I_`• LV Application Accepted B ' BateArea Employee IDN Final Inspection By >� Dale — -%Z-B� ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 F[: Pit/Sump Soil Character. COMMENTS oS- ilh n fe- !r¢FoL /�U ��AhJ�t 'CA PE SC Received Ch Amount Date Permit/ Invoice# Permit ID# Code INFO BY Cash Remitted Service Request# t)2,551 r - 42-02-001 ONSITE WASTEWATER PERMIT