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<br />EA./RA-00N DATE
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<br />Date -A:1-4 ; Al*a±jj Etttployee 17:54.44ick
<br />SPECIAL PERtirr -Aorroved by
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<br />Septit.44 Roquistt * _
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<br />Apation
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<br />ONSiTE wASIEWATEP IRTMAT SYSTEM PPAST
<br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT
<br />SAN JOACAN,I COUNTY EAC4P4iONMENTAL *MALT', DEPio ruoc SEE E HAzELTDN AvEnue S tocRras CA $255- iag-342c
<br />NON-REFuNDABLE PER/Art CALL f1091153-7897 OR &SPEC OCAS EXPIRES IYEAR FROM DATE IsSIJED
<br />iale ADDRESS 4jf4T7g2r cfrE,_ I
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<br />OvaiER ADDRESS ,
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<br />REPLA4 ENE AT Oir-O-SER6CE SEPTIC SYsrEN OErraucTioN •,
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<br />,ARE EY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL SE DONE IN ACCORDANCE WITH SAN -40AO4jIN ODuoin' "S,
<br />STATE LAWS ANO RULES AND f4r DLit-1470ra OF SAN .t0ACUIN COVITY
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<br />NCE NOTICE' Fef QUIRf P FOR INSPECTIONS - PLE.ASE CALL, (209)953-7607
<br />E 1.0“-,-Aqzrar DATE
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<br />INSTALLATION WILL SERVE:
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<br />Cl GREASE TRAP
<br />Cl LIFT STATION SIZE TYPE Of PUMP J PKG TX PLANT
<br />LAJES LEACHINO CHAMBERS
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