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�"� <br /> ' ^ ONSITE WASTEWATER TREATMENT SYSTEM PEK�|�AT ' ' <br /> -SAN JxA,,1"wCOUNTY ENVIRONMENTAL xs^LToDEPARTMENT ,wmc.*AZeoOmAVENUE'onOCxm"xAo62m'm09>*e-3mo <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPEC77ONS ExPIRES 1 YEAR FROM DATE ISSUED <br /> CROSS STREET VCA 94-ke4l n A!> f Pit PARCEL SIZE <br /> OWNER NAME t-4tv r% FW Ing j'Ar— <br /> OWNER ADDRESS Crry/STATE/Zip <br /> CONTRACTOR A PHONE-.4 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: c""m/^ate= xr_________ <br /> TYPE OF WORK: <br /> NEW INSTALLATION REPAiRlAnorrioN ENGINEER DESIGNED ERNJLIWF <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM Al DEsTRu N 44014 <br /> 0-grPENCE -45 <br /> INSTALLATION WILL SERVE: ., VTHER id <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:............... NUMBER OF EMPLOYEES: <br /> V"SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> U GREASE TRAP n°EIwpu CAPACITY ` ou/ wmcompARruaNT <br /> DiSTANCEmNEAREST: WELL x FOUNDATION-.--W-2-�O . o PROPFATYuNE �u�o <br /> L1 uprmrATmw SIZE ______,r,psoppomp_______o ,xamPLANT o SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ---------------'- ------------ ---- <br /> P"uaACxLINES Ls^cx/wano^mosno uwES Lems,xnruwm n <br /> DISTANCE`uNEAREST wsuAlzmm-N�x mowDAT m° I I pnmPEpTYumc_.7»�cit <br /> 13 FILTER BED w.DT"________o LEwGT" __-n oem* it <br /> DISTANCE To NEAREST WELL_______x FOUNDATION________III PROPERTY LJNEo <br /> L3 MmNosu WIDTH___-------- _-o LENGTH_ u ospm � <br /> DISTANCE To NEAREST WELL____ .......... o pOUwmvw° __ n PROPERTY LINa_________o <br /> C3 nuMpo ftww________u LEwuTH __-: oe,m It <br /> DISTANCE mNEAREST WELL_______v FOUNDATION PROPERTY poorm,LINE « <br /> U DISPOSAL PONDS WIDTH x LENGTH............ ....._______ .........__n DEPTH It <br /> DISTANCE mNEAREST WELL-— It FOUNDATION_ PROPERTY LINE o <br /> CI SEEPAGE PITS mmveR_____-___- wm=/ ospm � <br /> DISTANCE n,NEAREST WELL ft pm°nATION ______o PROPERTY LINE ...... <br /> _________* <br /> / HEREBY CERTIFY THAT/ HAVE PREPARED THIS m,ruc^rmw AND THAT THE WORK WILL os oows IN ACCORDANCE WITH o^m <br /> JpwoowCOUNTY ORDINANCES.STATE L^wy AND nu/Eo AND nsuuL^rmwo. / ALSO usnnp/ THAT mv nsoumeo uoswos IS | <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS x`^rc uucwas ooxnn AND THAT / mw IN COMPLIANCE WITH ALL / <br /> WORKERS COMPENSATION LAWS. <br /> MINMU L4 ADVAWE NOTICE REQUIRED FOR INSPECTIONS-FLEASE CALL(209)953-769 <br /> uIGwso ............. nxu,_ -____- "°.E ' <br /> lip <br /> Ell <br /> 7 T4 1 1 11 <br /> DEfAlITMENT USE ONLY <br /> Application Accepted B te---- Area Employee ID#. <br /> Final Inspectilon By Date <br /> Character of Soil to 0;1�of 3 ------- Ump Soil Character: <br /> COMMENTS <br /> PE SC Received hack Amount Date arm Invoice P4 <br /> Code INFO 13v, Remitted j Service Request <br /> �mncw^�o�rnr�u�unTswp�mn <br /> *cv. = <br /> mvv <br />