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112/24/2029 10:91 AM PSI <br /> W-1�'AOUIN COUNTY EWVIROfftAIENiRI HEALTH SITE MENTAL EWASTEWFATERALTH TREATMENBESYSTEMNPERMI�CA962Ds-(2a9)asaaazo <br /> INS E. HAZI_L10N AVE. FF CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> and 26850 Lower Sacramento Road <br /> SIOCKIOff1 CA 952D5 CITYILP GafV96832 <br /> APN 005-030-07 and 005-020-02 PARCEL SIZE 78.6AC �Y <br /> IERNINk NE: E8690401 ment,clo Frank Smith F • PHONE 610468-9219 <br /> (�[ [ Run Ct. J, CITYlS7ATEfLP Morgan Hill,CA 95037 <br /> ORDER !I. fO56O5111 PHONE 209334-8813 <br /> I °X2t80 CITY/STATE/ZIP Lod,CA 95241 <br /> PORIi OTHER NUMBER EXPIRATION DATE <br /> SERVICE PROM OR 0EII PE,.. i6O,OO ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> Q 1T BUILDING PERMIT# LAND USE APPLICATION# <br /> 81785 NEW INSTALLATION rl REPAIR/AODmON rl ENGINEER DESIGNED IALTERNATIVE <br /> (' f REPLACEMENT ❑ OUT-0F-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> AGENC'I�JU 10 1hI: 00.00 -- ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> 11] 1: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES' <br /> LExISfIEXIS SERVICE EEE. Q 1 .110 _MFG CAPACITY gal #OF COMPARTMENTS <br /> �J (USDMFG CAPACITY gal /OF COMPARTMENTS <br /> TOTAL , 41i7 <br /> 7777 ,`I��tt D ANCE TO NEAREST: WELL It FOUNDATION R PROPERTY LINE R <br /> - TYPEOFPUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ........................................ <br /> CARD ��: 52Z3 MASIERCARD EACHINGCHAMBERS OF LINES LENGTHOFLINEs It <br /> CHIP READ-CONIACI ANCE To NEAREST RLLLENGhI ft FOUNDATION ft PROPERTY LINE It <br /> PAYfIENI: CREDIT <br /> n DEPTH ft <br /> NODEE: ISSUER ANCE TO NEAREST WELL it FOUNDATION n PROPERTY LINE It <br /> dT11ft LENGTH ft DEPTH it <br /> MID. ��r.I•►••�.+^t•i4D30 ANCE TO NEAREST WELL ft FOUNDATIONR PROPERTY UNE n <br /> fH ft LENGTH R DEPTH ft <br /> TIO: :I:hI:.��,�1a.D30 ANCE TO NEAREST WELL It FOUNDATION fl PROPERTYLINE ft <br /> AUIH CODE: 02708P rH R LENGTH ft DEPTH fl <br /> ONCE TO NEAREST WELL_ft FOUNDATION ft PROPERTY LINE ft <br /> APP I.ABf.I: hIASiERCARD MR WIDTHR DEPTH It <br /> CUM: f10 SIG REWIPED ONCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it <br /> AID. AOOOOODOO4101D -PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> IC. ADVANCe NOTICE REQUIRED FOR! SPECTIO S-PLEASE CALL 209 9,53-769 <br /> 7 <br /> �II NUNI: $777 1O TITLE!' �iLV/L- F/1 Ms7(�( DATE <br /> X'k CARD API)ROVEO x.l� YM��T <br /> ------ T----------- Cel <br /> 24 <br /> AMOUNT NO: - 2020 <br /> #7ZZ.4D oNM CO�N1Y <br /> — — ----------------------- <br /> - __ ,P'gRIrQN.r <br /> CUSIONER COPY <br /> ARTMENTUS NLY <br /> at- Area Employee]D# <br /> Data ❑ SP IAL PERMIT-Approved by <br /> 3 Ft: Pit/Sump Soil Character: <br /> WtAMENTS <br /> PE SC Received Chec"I Amount Perm U <br /> Code INFO B ash Remitted Data Service Re uest M Involce# Permit ID# <br /> 42-01 <br /> 4!14110 � {-�1 I I) �f`G I I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 'Ltt"" <br />