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LIQUID WASTE PERMI' SAN JOA'IrUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEN��KEALTH DIVISION 0• FLOOR, • (209)46873420 NON-REFUNDABLEFROM •: ADDRESS2_76 0 [)U If=s MAT) ►1 ► . ••• � .` �• Im CONTRACTORDA. L! 1 4(= \tJkI,&%j WAY \ rw' arra GEOGRAPHICAL INFORMATION: COORDIANTES: X_ TOWNSHIP RANGE-SECTION PERCTEST(S) HOWMANY APPLICATION#: TYPE OF SEPTIC WORK: NEW INSTALLATION X REPAIR/ADDITION DESTRUCTION INSTALLATION WILL SERVE: . RESIDENCE 0 COMMERICIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF ' RMP ES- CHARACTER RED _ r ! 11 SEPTIC TANK/GREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS 0 PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION- PROPERTY LINE 0 LIFT STATION SIZE TYPE OF PUMP- SAND. YLEACHING LINE NUMBER&LENGTH OF LINES I / 1 1 DISTANCE TO NEAREST: WELL i r.• 0 FILTER BED WIDTH LENGTH- DEPTH_ DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LINE . MOUNDED WIDTH - LENGTH DEPTH DISTANCE TO NEAREST: WELL - FOUNDATION - PROPERTY )<SEEPAGE PITS WIDTH w DEPTH DISTANCE TO NEAREST: WELL FOUNDATION 0 PROPERTY LINE ■ sumps WIDTHDEPTH DISTANCE TO -FOUNDATION • 11 DISPOSAL PONDS . DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PR•. . COUNTY ••Y-CERTIFY THAT I HAVE PREPARED THIS • • DONE IN •��.1� .�►►►� ��. > .ice. __ �• � ■(■NNI■'■i��l�ltt�l�l�l�l�l�l�l�i■I■I�I�NI�NI�!!!!!!!!!!!■!!!!!!!!!!MEMO' , ■li■iti�i■N!�I■I■I■I■I■I■I�I�(iiiii�I��;�Nl�lw��l�l�l�l■1■1�1■!■1■�•1•:::: ■I�iii■i■ItI■I■I■I■I■I■I■I■I■IFIL:'Ilia1al0� —._Ir��G�i��■�■�■�■m■w■m■N■m■■■■■ ■I■I■11I�I■ItI�I�I■I■I■I■I■I■I■I\I�I�I�l■lil■lel■I■i�iiiii�li._:_:_/:, !■�■! ■li��%�%I�_I�_I�_I�_Irl■I■I■I■I■I■I�I�I�1�1�1 !s_►l iVii :-111111 1■1■��9��•n■■ ■■■■IllI■ii■Iiii■iiiIiii■iiiIiii■iiiIiii■iiilIii■��iIili■��iIlii■��iIlli■�Illl■■■IIIl■■■eIIIl■■[!II�!r�:!iI!�II�■CIIII!�■■�III1�■��III1■SC■IIII■iiII��II�iIlliliioll■i1i■1■1■1�1t1i■i1�■s1i■ii1i■1�m■■m■m■m■!■!■u�■!■■!-■!.!-■! ON MEN WIN 11010-10 ■ ■ ■m■- �smimllloliiiii■ i ---- ■hiiiiiiiiiiiiiii�l�l�l[IfilCl%1■1■I■1■1■lit■�ililii�liiiiiiii■ii■u■��Mimi ■1■��i■�■�■�■I■1■I■I■I■1��!��!��■1■1■1■1■1�1i1■1■1■�■�■�■�■i■■ii�ii�i��l�M■1 •---._.—._ lilil/I�i■lilili�iiiii ■i■■■■■■ l■om,■� ■IV-■i��■�■I■1■1�1■1�1■I■1�1■1■1�1■1■1■1■1■----------------------�--------------• ■liiiiiiiliiit■Iil�l�li1■1■I■1■1■1■1■1■lit■1■1■1■1■1■�■1��■■■■�■■■■■�■�■�■�■� ■liiiii�ilililil�iil�f■1■1■1■1■1■1■lilililililMill■ii��11IIIIIHEMEME 1 1 ■lii■iiiiiiiililil■1■u1■1■1■1■1■lilililiii�i�iilii■i■i■■■101011.�:;:; ■Niii■i11iii0■■■■�■��I�1M1 ■i'ii■1•ii-�ei■iii■iiiiiilil■1 1■1®1■1■IN■IN■1�1�1■IA��iN■N■i■ii��i■�■�■�■�■�■� ■i�■1�■e■ ■ ■0■ ■1■1■1■1■1■1�1■1■IN■IN■INOI I�i��Nt�Nt®t■m Emu 11-11MR!