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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAoum COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 E.HAZELTON AYEmE-STOCKTON CA 96205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 .9{53-7697 FOR INSPECTIOA/S EXPIRES 1 YEAR FRDM DATE ISSUED <br /> J.ADOPESI2s- ] !� CrTY/Zr <br /> CROSS STREET _yak �c. C��T'� F?V e— API I � / � I I PA( LS <br /> R'CELSZff I A"J <br /> 0 > <br /> OWNER NAME NONE <br /> PHONEY�Dd•59 S_-3j k-7 I I± <br /> OWNER ADDRESS G•S` C'�' n s /E'_ C111SYAT&Z, S tJ�k1�•j1/ �:! 1'j S `'�' ' <br /> ! CONTRACTOR /�- �j7 <br /> CONTRACTOR <br /> �ADDRESS J 76 '^'' J//� /Pj� CRY/STATFJZW J!/GGIkLl" <br /> iLICENSE -.J�s2 rl Cae OD1E11 NUMBER 4/S71' -5i)(PIRATION DATE��> ZC <br /> WATER TAxLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordirwee X Y <br /> PERC TEST E BUILDING PERMIT! LAND USE APPLICATION! <br /> TYPE OF WORK: NEW INSTALLATION REPAWAoDmow ENOeIEER DEBKiN ED! TERNATIVE <br /> REPLACPIMNY OUT-OF-SERVICE SEPTIC SYSTEM DEarRtIDTKkI <br /> INSTALLATION WILL SERVE: RESOENCE COMMERCIAL L OTTER <br /> NUMBER OF LnWG Uwrrs: NUMRR OF BED 800616: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE`WG CAPACITY <br /> gal #OF COMPARTM• <br /> ❑ GREASE TRAP TYPE/MFG C;,PACITv pal AI OF COMPARTIMNTS <br /> DISTANCE TO NEAREST: VVs_L It FOUNDATON ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE _ TYPE OF PUMP O PKG TA PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHINGCHAMBETtS BOF LINES LENGTH OF LINES ft I <br /> DISTANCE TO NEAREST VJFU_ R FOVNDATION R PROPERTY UNE R <br /> ❑ FILTER BED WvrH R L.-jGTN ft DAH R <br /> DISTANCE To NEAREST WELL R FOUNDATION R PROPERTYLINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FouNGATON R PROPERTY UNE R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROP677Y LINE Y, <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST 'AHL ft FOUNDATION R PROPERTY UNE It <br /> ❑ SEEPAGE PITS NUMBER. WIDTH_ R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY UNE ft <br /> (HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE W ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN"QUIN COUNTY. <br /> 953_769 <br /> SIGNED ��' TITLE_/ -_ DATE <br /> I I <br /> REc MENT <br /> FI vF� <br /> APR 22 2020 <br /> N <br /> `I RO USN CSU <br /> IRjEjTH DEMRTMENTy <br /> lJO <br /> DEPARTMENT <br /> Application Accepted By Date Area � Empbyee IDM <br /> Final Inspection By77 _ Dal°J-1/ZLt /I_L C L SPECIAL PERNIT-Approved M <br /> Character of Soil to Depth 0113 A: Pitr*mp Sou Character: <br /> COMMENTS I-b±)L (_a-Lukl&I) T RRL f- w/ 3DL <br /> ^✓r l (A 442 "f IST A 07 6 A,4L .'L IL 4,41 VVA J <br /> hTAC O,N <br /> PE RStxIVW Cfaelle/ Amount Pwnw <br /> Code 111Fo I Remitted �° serviceuast It IrnO1Ce# Permit IDE <br /> SR <br /> 42-01 <br /> 4'14/414/iD / ONSITE WASTEWATER TRTMNT SYSTEM PERMT <br />