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JRAh (A I \(Af) 'I I I n I <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQj1N C"Nry ENVIRONMENTAL HEALTH DEPARTMENT 1868 E, HAZELTON AVENUE - STICKTO14 CA 95205 - (209) 468-3420 <br />t­ci,i-Rr7UNDA8LE PERMIT CALL "0 953-7697 FOR Ar3ps;770ys ExpiRFs 1 YEAR FROM DATE ISSUED <br />Joe ADOPIESS <br />i4A #j <br />CROSS STAEF. APN PARCEL SME <br />• <br />PHONC ........... <br />OWNER NAmE . . ...... ..... . . ................... ... <br />OWNER Arx)R"s <br />CONTRACTOP PHONE <br />CONTRACTOR ADDAeSS 4 Sa7,aC1TYtSTATE2IP <br />i UcEmsE .,'.C42 C-36 OTHER NUMEA Evl;wion DATE <br />1 57 .. . I ­­ 11.11.11.11.111, 1 � . ..... ... ....... ------- - <br />WATER TABLE DEPTH: bot <br />- 1p, <br />PERC TEST 4 <br />...... .... . <br />ft GJ-OGRAPHtCAL INFORMATION: Coordirma" Y y <br />.. . . . .... - - ---- - - --- - -_-_--_-- <br />BUILDING PERMIT # LAND USE APPLICATION dl <br />r <br />x- REPLACEMENT <br />Out -Of-sEsvra SEPTIC SYSTEM <br />..... . <br />-Y DESTRU 131, <br />......... <br />INSTALLATION WILL SERVE z RESIDENCE <br />COMMEACtAt. <br />OTHER ... ...... . ..... . . ............... . ........ _....-......W <br />4- <br />NUMB, A OF LNING UNITS: NUMBER OF <br />BEOROO .-Art <br />NUMSER of SPAPLOYEES: <br />ti <br />SEP TIC TANK TYPE/MFG <br />CAPACITY. .... <br />--I! '0MPARTMF.NTS <br />C3 <br />CREASE TRAP TYPUMrG <br />CAPAIX Y <br />Qal A OF <br />DISTANCE TO NEAREST; WILL <br />it Fc.,Lm- Altc"' <br />4- <br />3 <br />LIFT STATION SIZE __TYPE Of PUMP . . .......... <br />U PKG TX PLANT Cj <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />i <br />LEACH LINES LEACHING CHAMBERS..... <br />LENGIIHOFLINES .. . .... ... ..... it <br />DISTANCE TO NEAREST WELL_ 4!.? <br />•PkC'PE%Jy <br />LINE'.2 <br />Q <br />FILTER BED WIDTH It LvNGTH <br />....... ...... .... . .......... ............................ .. ............... <br />DISTANCE TO NEAREST wrt.t . . . . ....... . <br />.. ft i'­jHDAT" <br />It PAOrIc"WYLINE - - --- -_ <br />0 <br />MOUNDED WIDTH .. . " .. I—. It LCNGTH <br />... ......... ...... ....... ... It <br />DEPTH,,,_ <br />DISTANCE To NEAREST VVO:. <br />SUMPS It L Fwml <br />....... .... <br />ft <br />• <br />DISTANCE TO NEAREST WELL <br />It F0UN14AT.CN <br />It Fw_wt�nfyuNr --- It <br />0 <br />DISPOSAL PONDS WinTs It LrNG,,�i <br />- . f <br />DF PT'i <br />..... <br />DISTANCE To NEAREST WE'.1.4. <br />R i kUVCA `Y LINE .. .. . ...... <br />0 <br />SEEPAGE PITS NUMBER W10TR <br />It DCPTii . . ...... <br />DISTANCE TO NFARESI Wr' i <br />It vowDAT'ON <br />ft VIAOPCATYLINX_ . 41 <br />iHEA9 <br />, BY CERTIFY THAT HAVE PREPARED THIS APPLICATION ANO THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQ(AN C <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY, <br />,IgyJ'M 24 NO MPECTIONS-PL <br />J Mq4DVANCE NOTICE REQUIRED FOR - <br />A -,E,,CALL 3- 9 <br />E s . <br />SIGNED <br />- _ <br />TITLE..._ <br />-_ <br />DATE <br />r <br />4- <br />? <br />�- � r� ._+-_ �'' `�-9__...._; �` � i� <br />I <br />�,.� <br />Vii...- <br />�� <br />�... <br />� <br />4- <br />7-1" <br />77 <br />'flo L f <br />Tj <br />L.. <br />..... <br />. .... <br />Ak?, jEPARrMENT.QS,E ONLY <br />Application Accv,• <br />Date Arai <br />Date SPECII <br />Final inspec a A ERMIT - Appi ;)vadd ty <br />Character of Soil to 6pthol3ft—_", WSuMpSoil Charader: __ .. . ...... <br />COMMENTS A :!!WS AMA94914► Aft, d <br />voice #- Permit. . tiii 3* _ <br />Pt SC Data Perm <br />C640 1INFO ! Service A4 <br />L <br />1 1147 1 -7 '7 ('1 <br />... .... . ...... .­...­..­.­ ... .... ....... ..... ...... ­­ ............ . .... ......... . <br />ONS;TE WASTEWAT En TATMNT S -STEM PCFlMtT <br />