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LIQUID WASTE PERMIT <br /> 1y1 SAN AMOURS COUNTY FICRUC IYALTII SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> VV ]N E,WESER AVE I°'FLOOR.Sr TON.CAME 12M)041<20NDABIX <br /> / P,RMREXPIRES IYEAR FROM olSI <br /> ��� PARCEL SITE:�•3J <br /> JOB ADDPRRS/�1 �j ^T '"'1111•• y�/�/ [Tn <br /> • fITYIEP I//JF9./KGR 1 3 J BUILD)NCPERMITF <br /> ONMEN NAMEJV/LNr, Lc� r.JA^AOU AWRf6Y <br /> CI'EYIGIP_,_ .- . PHONE NCMBEa LU 4 <br /> S "• _-_ 7 <br /> cONERACTDAL ADDRESS Ye 4 "05r?lry E <br /> ./ l.:a <br /> fITSZP_ C ? r--!IPHONE NOMBER <br /> I.� <br /> J'•? 1 <br /> GEOGRAPHICAL INFORMATION:C000.DINATi&Y _5"__- .- _TOWNSHIP_ _RRANNGE_SECSION__ <br /> TYPE Of SEPTIC WORK: INSTALLATION WILL SERVE: NUMBEROPLIVIVGUNITS: <br /> ❑ NEV/�INSf7.SLTl'!9 Ci RESIDENCE NUMBER OF BEDROOMS: <br /> EI R@IPAIRIADOITION' O COMMERCIAL <br /> d RUCITON fi'L�' ❑ OTHER _ NUMBER OF EMPLOYEES: <br /> ❑ CNOMEERFTLALTERNATIVC ff <br /> CHARACTER OF SOIL TO DEPTH OF J':_ PMSUMP SOIL CHARACTER: _WATERTABLE DEPTH: <br /> ❑ PIK TESTS) NOW MANY APPLICATIONS <br /> 8 SEPTIC TANK TYPEMFG 2 L ce-iLtft CAPACIT`( QU ROFCOMPARTMENTS?' <br /> ❑ GREASE TRV TYPE'MFG CAPACITY MOFCOMPARTMENTS <br /> ❑ PKGT%PIANT OISTANCETO NCAREBI: WELL_lJ CJ H)UNMTION-31�L PROPERTY LINf�L.J <br /> ❑ LIFTSTATION SIZE ... r5reol ttwF SAND OIL SEPARATOR(ENCUOlitO SYSIP.M) <br /> ' • � <br /> 6 LEACH LINE ROF LINES: LENGTH OF UNFS: _(} Ob{STAxcamnuRrsl: WRu.y= FOUNDAr" nor uNEL� c,` <br /> INFLITRATOERS: _" <br /> ❑ FILTERBED WNTN_ LENGTH_ DEMI OWAM MNAAc : WF1L__ FOUNOATION� FROPERTY LINE_ <br /> ❑ MOUNDEO WIDTH_ 1£NGTH_ OEPTX ol.Nl'AK'LTOxw2tT: WELL_ FOUNOAMOK� FROPPATY <br /> ® EUMK WIDTH LFJIRTN - iNL'LTOIIGi S � TIOE� /.7 FROPiMURE-/ <br /> ❑ DISPOBAL PONDS WIDTH_ ISNGTH—1 DEPT._ ONT+x[BIONAARLR: WEIA._ POUi®AnON__ MOPWW UNL_ <br /> ❑ SEEPAGE PITS B� WA.ETER _ OERN nAAnRTON[Y6T. WfiLL_ MUIDATRM_ PROPERTY LINR�� <br /> 1 HEREOF CERTIFY THAT I RAVE FREPA RED THIS APPLICATION AND THE WORK NYLL BE OOYE IN ACCORDANCE WT SAN"QUIN COUNTY ORMIXra7S STATE LFWS <br /> AND PULES AND RXGIJuTIFJNS OF SAN JOAQWN V.MnV. <br /> MIN'IMUMA\CE NOTICE REQUIRED FOR INSPECTIONS-PLEA%E CALL(209)A6B•3RI <br /> SIGNER: �! TITLE: OF.A.AJ/r DATE: �L?/fir <br /> .. ... <br /> 1 _ <br /> _.. .... <br /> �14 <br /> .j.. <br /> .. ; I 1 <br /> I �rnn ,I _, ; <br /> .. Y RE�I..F ( .. �i� � i r j j <br /> :.ter ! <br /> t <br /> UUryry _ _i _ <br /> SANJ UI S�AHJICES f .j <br /> I NMFLiN_yI EpJTd111R+7Lw _ i 1 � 1 V 1 .. 1 j L.. .— <br /> APFUCATFON AL lr BY: Ere. ..•.. :EMPLOYEEIM ♦ OISIRIC "P�LDCATNIN� ' <br /> DATE: <br /> 2` �Y pER�L1ITFlYAL YFji,WTE:F/L3/J✓IN9YF[T119: <br /> • COMMEMS__ �N\L•L•R-A^� S�\� �a YYi •�Ld lN•�L .�p��e16dLYY.Yedil. 7 _ <br /> PEf KINFO AMWM CIIEC N RE'EryFO DAIS pFAMIi:YEIVICE 0.EN15TY INVOKER SFITIC IO. <br /> RF111RFp BY <br /> NFOA�1`Z�b ES b'0 e{� � ' ZyaL bOZg d <br /> D—, <br />