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j1 <vA LIQUID WASTE PERMIT <br /> SAN MAQUN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBLR AVE "FLOOR,SIOCXTON,CA 953N(3W)i6XJOD <br /> >> ,,II (I {/,1� r NQ( -RR�EFUNDABLE,PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JGRAUDRP1841L„-LD P / IKTri-saN "W Am 063—RL30-36^^ PARCELSIZE:2.02- <br /> O.M. <br /> ,02 <br /> C.M. I-00L BUILDINGPERMrcx Y �O /. �Jq <br /> OWNERNAME TEEIEFrALl P TEARS ADDRESS = <br /> CEIYZP """ PHONE.NUMBER <br /> CONTRACTOFn-R� C/LJEe PIP THON9�SoW ACkIL01PPg EMIT ADDRESS <br /> CRY21P I'd 13OY I'IIH WILTCLL/ GN -17693 PHONE NUMBER ' <br /> GEOGRAPHICAL INFORMATION:COOROMATEC X Y TOWNSHIP RANGE SECTION <br /> TYPEOFSEPTICWORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> x-• NEWINSTALLATION 'p RESIDENCE NUMBER OF BEDROOMS: y <br /> REPAUVADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGMEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OFT: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TESTS, HOW MANY .J, APPLICATION <br /> LlSEPTICTANK TYPE/MFG COt,CrefG CAPACITY O0 ROFCOMPARTME.NTS ' <br /> ❑ GRLAEET¢AP TYPE(AFG CAPACITY NOFCOMPARTMENTS <br /> ❑ mGTX PLANT DInANCETONEAREST: WELL FOUNDATION PROPERTY LINE_ <br /> ❑ LIFT STATION SIZE mSOEPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) _ <br /> W ' <br /> ❑ LGCH LINE I OF LINES: LENGTH OF LINES:GO 1 ppTMCLTOXTAR6 WELL I J V FOUNDATION Z 7' <br /> PRgERTY LINE •0 1 <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH_ LENGTH_ DEPTH_ nreuXCETOKun : WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WID1N_ LENGTH_ DEPFN pMaxCeiOXGNLR WELL FOUNDAT)N PROPERTY LINE_ ' <br /> ❑ SUMP$ WIDTH IPNGTH_ DEPTH_ OIRTM'BiOxLLYEi[: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH �j�] DEPTH OLR.,nCETON[M&M': WELL_ FOUNDATION PROPERTY LINE_ <br /> El SEEPAGE ELEPAGE PITS p DIAMETE0.� DErtN 2a plA0.xt[TpxunvAT: WELT/` ' TOUNDATION_ PROPERTY LINE <br /> I HEREBY CERTIFYTHAT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE �N JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND RECITATIONS OF SAN JOAQUIN COUNTY. <br /> IMUM 14 HOURADVANCENOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(109)/611-3473 t <br /> SIGNS i+ L-ct� .J TITLE:d G'CWr-'— DAT ZZ O� <br /> 6 <br /> LLJ <br /> m <br /> iT y <br /> I I <br /> ti v4°f. .. <br /> 'Ib%' � <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY: _ -_ DATE. r 1.l a'AREA 1-1 <br /> `1- EMPLOYEE IM' OISIRI/C/T/�//IpCAT1/ON�� ' <br /> INSPECITDBY:� _ uATE IO�AD�OA PERMITRNAL YES OATS:Ar:A$&n—P`7Tos`- <br /> COMMENTS, S /Op�S Geflt+.TS� �G�Z9 '�1 _ <br /> PECODF SC NFO .0u., CN CASH RFSEIYFL DATE PDUAI SE¢VKEREgFET[ DNOKFN ;EPIYIp <br /> REMITTED BY <br /> 4111 11Y 3-l.0 SRW30 qS <br /> acvrseB Ll}LI <br />