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ONSITE WAST I•WATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D,,.,RTMENT 304 E WEBER *,**3""FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDA LE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED \ICXAU y Jos ADDRESS CITYILIPv m APN1�9 aff CROSS STREET r /��.1 PARCEL 51LE7 OWNERNAME ISYMM NG PRONE / C �/ e^r7 5 E /'/� _9 OWNER ADDRESS D 1� J.fNVi-- INC, ITY/STATI;/ZI /�1�.�. j^Cy�IJ�"1_' 7 I CONTRACTOR //L(�y��•' '.`�1�I 8 a 10f�]15, " - PDONE4lJ6 .AoJV•^//r/Y' CONTRACTOR ADDRESS-Tl_i l / N � /WWWW —AsY 1/'CIITY/STATE/ZIP CMM /544/ LICENSE C-42 ❑C-36 OTUER ! \ NUMBER 10 5I ' EXPIRATION DATE I O_y� 40 WATER TABLE DEPTH: H GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST(S) NUMBER LAND USE APPLICATION q TYPE OF WORK: x NEWINSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE. COMMERCIAL. OTHER G NUMBER OF LIVING UNITS: // ` ' NUMBER OF BEDROOMS: I �/^per/ U BER OF EMPLOYEES: Q SEPTIC TANK TYPE/M1CC C1 CAPACITY�V gal #OFCOMPARTMENTS G ❑ GREASE TRAP TYPEIMFG CAPACITY gal q OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE R ❑ LIFTSTATION SIZE TYPE nOF1PPU�M,P ❑ nSAND OIL SEPARATOR(ENCLOSSEDSYSTEM) � XLEACH LINES LEACHING CHAMBERS'L�TYt',I�—LINE ,�G-7 q OF LINES �2� LENGTH OF LINES 100 DISTANCE TO NEAREST WELLYVbIIcWAT ATION lam/` B PROPERTY LINE 5*- _ R ❑ FILTER BED WIDTH R 'LENGTH R DEPTH I R DISTANCE TO NEAREST WELL R FOUNDATION Il PROPERTY LINE R ❑ MOUNDED WIDTH H LENGTH R DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R ❑ SUMPS WIDTH R LENGTH R DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R O DISPOSAL PONDS WIDTH R LENGTH R DEPTH II DISTANC O NEA EST WELL R FOUNDATION Il PROPERTY LINE 0 Jd, SEEPAGE PITS WIDTH a LENGTH III /J��,�}},��,�� \ � 1'ISR DEPTH R DISTANCETONEAREST WELL VIa.. Wrlal@AlrynnlON� W�IIS R PROPERTY LINE. R 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. n,, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 11 (7/1I gJ1n )MIN 24��CE NOTICE REQUIRED FOR 'IONS- ' F.CALL(2119)953-7697 SIGNED�.�J`� I\I /�, ��p111�J1 TITLE DATE 11 O / I yC O .. � ICrm rq V,NO 1 m� A , � O11 B �N — m yl� . —_ V_._...- y In ®A. P- (i��►al� - - ---- ------------------ -- ° --- L�T132.------------ FUTURE L.Fia 4 N PIWSIUN 1 100/ D' PERFORATED PIPEMCI �Vz �I o� Nm. :m _ ,rr• ? x I Zm PAYMEQ�JT \ RECEIVED e� bIi z .(z�_ \1J xh A ___-_ ___. _ -MAR 21 2003 _ DEPARTMENT USE /r^/-O��N-��L�Yq-- ^1 PUBLIC HEALTH SE N S Application Accepted Date` L9%(I Arca � IA C E�d by N Final Inspection By Dale Q SPECIAL PERMIT-Approved by Character of Soil to Depth of®®f 3 Ft: PI SBmp Soil Character: COMMENTS AA�(a ary,p wpm PE SC Received — Amoont Dote Permit/ Involve q Permit IDq Code INFO B as Remitted Service R Best q am Lu 131k, 31 42-01-001 1_2j/2/02 ONSITE WASTEWATER PERMIT FST