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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOLAN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1968 E.HAZELTON AVENUE•STOCKTON CA 95205•(209)48&3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Jon ADOnass 3 LI'L` E jjha YT1 (» CTrrRIPY�Lr/.H(i'/ 9'�2 O z CROSS STREET[[}}Il'\E7w woy ILO APN C) JAI?�.� PARCEL SIZE f•�± OWNER NAME SILL f,L,,H S PHONE OWNER ADOPI a, -. CITY/STATE/ZIP CONTRACTORJ, �LIi✓Sj)t\,�•�p,�_ SCpctz��lii�, PHONE CONTRACTORADOREES Zy71 YAVAArjWV C0L*U('- CRY/STATE2IP S!K•tA""•;N/D/CA/9S$Z,�_ LICENSE L.C-12 C-M OTHER NUMBER 971'/Z U ExPIRATION DATE CG/Z D 1 WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST 0 --1 BUILDING PERMIT X LAND USE APPLICATION X TYPE OF WORK: NEW INSTALLATION REPAIR/ADDRION ENGINEER DESIGNE /ALTERyATNE REPLACEMENT 7'-,,P j r-111 OUT-OF-SERVICE SEPTIC SYSTEM )4 DESTRUCTION �a,n\ INSTALLATION WILL SERVE: RESIDENCE I ; COMMERCIAL OTHER NUMBER OF LmNG UNITS: NUMBER OF BEDROOMS: _- 7 __ NUMBER OF EMPLOYEES: �7 bl SEPTIC TANK TYPE/MFG d1 G CAPACITY /70() gal M OF COMPARi MENTS G ❑ GREASE TRAP TYPIP/Mpc, CAPACITY pal A OF COMPARTMENTS DISTANCE TO NEAREST: MAI ft FOUNDATION R PROPERTY LINE R ❑ LIFT STATION SIZE _ _- - TYPE OF PUMP-_._ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) O LEACH LINES LEACHING CHAMBERS /ti�_ffrslg� /OF LINES LENGTH OF LINES S-2 rt DISTANCE TO NEAREST WELL Ioo R FOUNDATION �p• R PROPERTY LINE /S R ❑ FILTER BED WIDTH ft LENGTH R DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY UNE R ❑ MOUNDED WIDTH ft LENGTH R DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R ❑ SUMPS WIDTH It LENGTH R DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R/ SEEPAGE PITS NUMBER / ---- WIDTH /;? � R DEPTH 2S' R DISTANCE TO NEAREST WELL AWISD R FOUNDATION IOD, ft PROPERTY LINE /S R I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 44 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL aD91.953-M9Z SIGNED_ — --_._-- —_-- _--- TITLE?!`t' [{c•✓t _ DATE 04 I O 1-020 RE YMEN CFS AFD APR ^'/0,q ov/� ?� TN OE gRV7�Nry NT TT--a I I 1 1 . 1 1 1 1 1 -- #-- 1 -1 i OEPA Application Accepted �`�� Dets_`i! S L l Arae `( 611- Employee IDN -'K Final Inspection By - Date•LV' W SPECIAL PERMIT-Approved by Character of Boll to 6apth of 3 FI- Pit/SBoll Character: COMME TS J I)J\4,� rec,5q"' �f ��a�csor.me,1 um er 111T y_� � w - lie �_ 2 Ch" - Amounnt --- -� PertnTV —'- Coda I INFO Omn I Cash Remitted Service Service R 1 I Invoice I Permit IDI w�—�TEI� `'J `/)• ' �� TR TMNT;r37FM PERMIT 42.01 utvte