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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT ; (.
<br />SAN JOAOUIN COUNTY ENVIRONMENrAt• HEALTH DEPARIMENT 1868 E. HAZELTCN AVENUE • SiOCKION CA 95205 - (209) 468.3420
<br />NON-REFUNDABLE PERMIT CALL �d9) 953-7469t.7FnINSPECTtONS ExpIRfs t YEAR FROM (TATE ISSUED
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<br />OwNERNAME y it Lam, 7+ __ PttoNE.�f
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<br />CONTRACTOR AmA___ &.' L'sI ." ..�..✓ o✓.__... ._.__..,..f»w,C.. ..,.,r GITYJS TATE1ZtP ._ � Y.'.., .,.., K, ..+ ..F -L--i- -
<br />LICENSE
<br />" C36 a7triER./3>,iy '* I NutaA._ i .J.'/ ltiIaAru�eai]ATE_.__ -
<br />WATER TABLE DEPTH: _..._....____„_...... _ It GEOGRAPHICALINIFORMAT'IOW Cootdlnatas X.
<br />EC TEST i _ _ _ SUiLD040 PEROT # _ ___.. LAND USE APPLICATION # _--
<br />i _ __ _ .. _ _ __r_sYGI1 EEIi IiiEDIiO iEFWATW£
<br />TYPE OF WORK; NEW INSTALLxTwN FtEPAactADDRtOtt V
<br />REPLACEMENT_ . = OUT<OF-SMIC f SEPTIC SYSTEL DESTRUCTION A,; IS.E.-_____ _„.
<br />INSTALLATION WILL SERVE RFSIDCNCE Crr4I l+61Ai OTHER.
<br />NUtABEA of LIV3NG UIWTS NUMBER OF BEDROOM% _ NUM6EA of EmpLOYF.GB
<br />LI SEPTICTANK TYPEAVO GApVtTr _ __ CaMPARTMfNT ___
<br />O GREASE TRAP TyPEJMf ____.,_. __. CAI°Aafty. , _ _.�_.._ 9 k OF COMPARTIAENTS__ .__._. _ _
<br />DKTANCETONEAREST; WELL ....._._...—_-..__.._ ft FOUWAT`M
<br />U LIFT STATION S;ZE .... ........ ._._ ..... TYK OF POW ...-._....... ..... _.... (a PXO TX PLANT C) SAND OIL SEPARATOR (ENCLOSED SYSTEftly
<br />❑ LEACHLINES
<br />LEACHING CHAMBERS . _....__._..... .___..
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<br />LENGTH OFLOO-S ... _..... ----------
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<br />DISTANCE TO NEAREST
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<br />DISTANCE 10 NEAREST
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<br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN
<br />JOAOUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REOUIRED LICENSE I5
<br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE IJCENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br />DE-PARTJWfNT USE ON �I �
<br />Application Accepted/If_J-j Data 7 1 - I// � .. Aron ...2 _ �. t3 2..._ Er"ptoyoe lot
<br />Final lnspection ByI Y SPECIAL PEANT•ApprOVed1SY
<br />Character of 5»31 to D pth of 9 F3: __ phlSwnp Sass# Character
<br />COMMENTS, _=_'_ _ ._._.._ _._ .._. __.._
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<br />42.01 ONSITEWASTEWAI�ER TRTMNT SYSTEM PERMIT
<br />SA.'17
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