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� <br /> | <br /> | <br /> � <br /> ONSITE WASTEWATERTR2ATN7ENT SYSTEM PERMIT <br /> SAN JOAQUIN COLINTI*`==ENT°HEALTH m,^== .'04s\%EBER^= 3""FL-�TOC" ,c`e202 - 209,41,8-3420 <br /> NON-PLEFUNDABLE PERMIT CALL(209)953--fig'FOR INIPFCTIO\", EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITv/zIP A- <br /> PARCEL SIZE <br /> OWNER NAME j. PHONE <br /> OWNER ADDRESS <br /> CONTRACTOR 21)— PHONE <br /> CONTRACTOR ADDRESS <br /> CITVISTATEIZIP -6, "J, <br /> LICENSE 0 C-42 13 C-36 OTHER NUMBER — ExPtRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: u°mm.es x _________ ,___________ <br /> - <br /> TYPE orWORK: o NEW INSTALLATION o xcPA."m""mm, 13 ENGINEER DESIGNED/ALTERNATIVE <br /> u n,,LACEmo° o oESTRoonon <br /> INSTALLATION WILL SERVE: LI RESIDENCE LI COMMERCIAL El OTHER <br /> u <br /> SEPTIC TANK TYPE/MFG o=o"_______ gal #=o=PAR=ENT"______ <br /> o <br /> GREASE TRAP TYPE/MFG u="._______ PI *=COMPARTMENTS_ <br /> o ,uor,PLANT DISTANCE,"NEAREST: vELL_________ x FOUNDATION_________ x PROPERTY LINE u <br /> El LIFT STATION SIZE_ r,,"o,,"°, o SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> o LEACH LINES 13 mAcx/nv CHAMBERS ^ vOFLINES______ LENGTH=LINES x <br /> DISTANCE=NEAREST WELL ft ="°"""=-------_x PROPERTY LINE_---------_It <br /> E3 FILTER BED WIDTH 111 LENGTH o""° x <br /> m=^NCE=wEA=" WELL It FOUNDATION ^ PROPERTY LINE x <br /> C3 wovmnoo WIDTH ft LENGTH ^ DEPT" It <br /> oIS="=mN="=, WELL ft FOUNDATION_ PROPERTY LINE__--_----_u <br /> El oow,m n°=__________n LENGTH ^ DEPTH n <br /> DISTANCE=NEAREST WELL ft FOUNDATION ft =v,="""" ^ <br /> oomroaL,ownw WIDTH ft �=, DEPTH o <br /> ' DISTANCE,"nEAREzr °=^________^ FOUNDATION u PROPERTY LINE o <br /> E3 SEEPAGE PITS NUMBER WIDTH ft o",= It <br /> m=""==nEA"=, WELL ft FOUNDATION_________« PROPERTY LINE —ft <br /> /HEREBY CERTIFY THAT/HAVE PREPARED THIS APPLICATION AND THE WORK WILL ooDONE/NACCORDANCE WITH SAN Jv^vv/°COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONSv,SAN Jo*wmCOUNTY. <br /> 0 N NOTICE REQUIRED FOR INSPE (2091953-7(07 <br /> SIGNED 17 TITLE 4� <br /> til VIEZ <br /> Lj <br /> DEPARTMENTUSE <br /> Application Accepted By Date—������--_ *= --___-- e=ployeeum____�__� <br /> Final Inspection By m=_________ o SPECIAL PERMIT'Approved by_______ <br /> Character°,Soil mDepth°nFt: Pit/Sump Soil Character! <br /> oomwEwr <br /> �� <br /> PE SIC Received QLe_gW— Amount Date erm I nvoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br />