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LIQUID WASTE PERMIT <br /> f SAN IOAQUN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH MVM*N <br /> 1M E.WEBER AVE 3-FLOOR STOCI(TON.CA O$M(M)M 344 ., <br /> S�`�`/% S�/(��JC M) NOABLP•PF.RMITEXPIRLSIYEAR FROM DATE ISSUED <br /> W <br /> MB AREBS / / A'. �) `'� <br /> • 7 O PARCEL,ES.- • 2 J&n. <br /> • CDYZP G 1�1�/pT /,.yLA/•S C4+' WILDING PERMITY_�//"��]P_OIOrI-� 7 <br /> OWNLR NAME \.'n WOi 'Y •riP II/ /A� /� •�f i�---��.-�---��� <br /> CTry21PJ� CP �L'(f�UF /.r"C YP 4'•xi <br /> /{ •Tr PBOXC FUMBCR <br /> CONTRALTOR 1.J 1 1 c �•ON:S•r <br /> GITYZp_�Sr`7 /] .�/�(� •�_ /�U% <br /> PHONE NUMBER (7 2 S-0 <br /> GEOGRAPHICAL INFORMATION:COORDINATES:% y <br /> TYPE Of SEPTIC WORK: INSTALLATIONWILLSERVE: NTIMBEROPLI"PIGUNFTS: <br /> Cl NEW INSTALLATION O RESIDENCE —� <br /> O REPADUADDITION ❑ COMMERCIN- NUMBER OF BEDROOMS: <br /> ❑ DESTRUCTION ❑ OTHER NUMBEROF EMPLOYEES: <br /> O ENGNEERED'ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF V: PITiSUMP SOIL CHARACTER: _µ <br /> WATER TABLE DEPTH: <br /> ❑ FEWTM,S) HOW MANY APPLICATION# <br /> IQ SPPITCTANK TYPEIMFG CAPACITY /on Z <br /> #OPCOMPARTMFNTS_ <br /> 13 GRFASFTMP TYP"FG CAPACITY NOFCOMPARTMENTS <br /> ❑ PKGT%PLAN DISTANCETONEAREST`. WEU__ <br /> FOUNDAT N_ %10PERTy NNE_ <br /> O LIFTSTAl1pN EI1F TTPEOFPVMP <br /> SANDOILSEPARATOR(ENCLOSED SYSTEM) <br /> LWCH LINE #OFLNES:--2—LENOTHOFL(NES:_ <br /> OMT.WCElDN4xpT: WE4 O PDUN.AMN PROPERTY LINE <br /> INttRRATOR LNAMtlER4: <br /> ❑ HLnRm MOTH— LEROTH— DORH� oDinnRTDx[10AT: wE4 <br /> WUNDATWN_ PRMERTY <br /> ❑ MOUNDED *"— UNOTN— DEPTH_ vnAnt[TONUM WELL {dINOATIDN <br /> PROPERTY 4M6yNp_ <br /> � <br /> ❑ #UMPE W TH— uWGTH— DFPTH_ EIRAxITTONwANe WE4 _ <br /> —� POUNBATWN PRpERTY DNF <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DFPDI�— otelu;LYTpx[Axm; WE4_ FOIINWTION� <br /> PROPERTY LINE <br /> • .1p_ SLVAGC PIIS #_� OIAM¢iFy Y'/ ---Z57,yp.xRMNueER: WELL FOUNDATION PROPERTY LME O <br /> I MERV CERTIPYTHAT I MAYEPRBPARED THIS App—LWATIDN ANDTHE WORK WILL BE DONE N ACCORDANCE WITH SAN <br /> fOAQU1N COUNTYONDINANCSS,STATE LAWS <br /> AMD RULES AND REGU LATI ONS OF SAN IOAOUIN COUNTY. <br /> .MI 1 EHOUR ADVANCE,NOTICE REQUIRED FOR INSPECTIONS-PLEAAECALL00P46*,34U l <br /> 6IGNED: •� - I s DATE:' a i.2YDDZ <br /> TITLE: <br /> -T <br /> I _ <br /> T <br /> 1 <br /> _ I <br /> Attz <br /> Lp <br /> LZ <br /> DEPARTMENT F-ON. <br /> MP{ICATWNA BY: TF; AREA .....IDY 1 <br /> BfRILT LOCATN)N <br /> VIRPE('I£DBY: ^ �1 i on ER:l?- v PPAAIITFINALE! YESDATU{• UA' <br /> INSPECTM: <br /> Pro MO <br /> 0.Q11 ED "MN A TVED AR PFRNRg6RVKEREO:ASTR INV R � <br /> 2! 87 34 Log <br /> o� 2 <br /> YY�YLHIT <br />