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^ ~ - — <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JuAQvINotoNT,ENVIRONMENTAL HEALTH DEPARTMENT `mmE.xAZpunwAVENUE'am,mOwu*xums'(2vw46o-3^20 <br /> NON-'REFUNDABLE PERMIT CALL(20q)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> CROSS STREET APN PARCEL SIZE "If,. <br /> OWNER NAME <br /> PHONE <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS _A93lee <br /> LICENSE -42 0-IC-36 OTHER NUMBER-i/ _9V TiON DATE..... <br /> VC ExpinA <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 7_1 PERC TEST 0 Fg5ILDING PERMIT ................ LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIWAoDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHEFI_ <br /> NUMBER OF LIVING UNITS: NUMBER OF NUMBER OF EMPLOYEES: <br /> L3 GREASE TRAP TYPE/MFG CAPACITY_. #OF COMPARTMENTS <br /> DISTANCE roNEAREST: wsLL _______ : ewwoAIm* o PROPERTY LINE —ft <br /> C] LIFT STATION SIZE ______r,psp,pvMp_____- o ,xmrxPLANT o SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES o LEACHING CHAMBERS_______ ....... ....._ ........ vm^LINES_A= LENGTH nrLINES o <br /> � <br /> DISTANCE mNEAREST WELL, �_ x nmmmxmw_ ^ PROPERTY LINE It <br /> (3 FILTER BED vwmm____ ........___n LENGTH _..... ................ ______n os,* It <br /> DISTANCE`nNEAREST waLL______'oFOUNDATION o PROPERTY LINE x <br /> o Mouwoco WIDTH It Ls*omo DEPTH it <br /> DISTANCE mNEAREST *ELL—_ it FOUNDATION-.--ft PROPERTY LINE o <br /> L3 oumpe WIDTH it LENGTH .................._.................._-_____x DEPTH ft <br /> DISTANCE n,NEAREST wsLL______ ft nmNDmrm* o pmOPsnr,uws_________o <br /> L3 DISPOSAL PONDS WIDTH it LENGTH_ ............... osn* n <br /> DISTANCE n,w x m,m�^mw x PROPERTY LINE <br /> �� osepxaspn� m=om �� �, ocpIf ^ � <br /> �� °�_____ ~~.. � .. <br /> ' DISTANCE wNEAREST weu_- n FOUNDATION 1120 n mo,sonuwE— u <br /> /osnsov CERTIFY THAT/ HAVE PREPARED THIS wppucxnuw AND THAT THE WORK WILL os oowc IN xccunoAwus WITH a«w <br /> Juxouw COUNTY ORDINANCES, o`^rs uwvo'AND RULES AND REGULATIONS.REGULATIONS. / ALSO CERTIFY THAT mvnsowmsoLoswas m | <br /> Cunnswr AND ACTIVE wnx�� CALIFORNIA CONTRACTORS STATE ucswos auxno AND THAT / AM IN mmmpu^m*s WITH ALL / <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR aDVANCE NOTICE REQUIRED FOR INSPEC77ONS-PLEASE CALL f209)953-769 <br /> 1 IGNED TITLE DATE <br /> NT <br /> 1.0 2019 <br /> MIA Irm ENT <br /> I LL <br /> *NOTL� <br /> ;L-y 1 11 -1 1 <br /> Application Accepted By ""t D at. Area Employee lD# <br /> Final Inspection By: f-_Ft! 9 <br /> Character of Soil t Depth f 3 F V, mp Soil Character: <br /> COMMENTS A .< hoa A Adige/11 <br /> PE SC Received Amount Permitt Invoice Permit ID* <br /> Pods INro_ BY ash Remitted <br /> ^ . <br /> mm ONSITE WASTEWATER rRTuNTSYSTEM PERMIT <br /> 5/5/1' <br />