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LIQUID WASTE PERMIT <br /> SAN IOAQiHN T=L EALTH SERVICES <br /> MHLTH DIVISION <br /> )q AXF WOR,SIOLKIONCA <br /> 93=009)44R 31ID <br /> NON.REPUNDABL6PERMITEXPIRCBI VCAR FHOMB T(�C ISSU 'E <br /> ,O.ADDRE%J�3/ '� y' ffi� APNY� ©7 VL PARCELSIZE: <br /> C,T•YMB, /N ,q BUILDING PERMUTE <br /> OWNERNAMEyP v.� /SILL. ] m.1 itl ADDRTbS <br /> ciwmP PHONE NUMBER <br /> (��f3j J�cJti{ <br /> CONTMCTIIR�{jJlj@�_� . <br /> ErrvmP ��i.. PHONE NUMBER SZ�Z-50af7 <br /> GEOGRAPHICAL INFORMATION; CCURDUTATES:K_ _ __Y, TOWNSHIP_ PANGC Sammi— <br /> TYPE OF SSMC WORK: INSTALLATION WILL SERVE: NUMBEROFUVINGIllAITS:� <br /> ❑ NEW INSTALLATION {Rn RESIDENCE NUMBEROF BEDROOMS: 3 <br /> l♦& REPAIR'ADDITMN ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEEREDIALTERNATIVE <br /> cHA CTEROP3 lLT M"HOP)': P✓/Dy— PIT/ UMPSOILCHARACEF.R:S�s� �Sqt� _WATERTAELEDEPTH1 <br /> ❑ PERcuu(s) HOW MANY APPLICATION IF <br /> SEPTIC TANK TYPER.FFG_ ;•Jw,, CAPACITY 1600 SOFCOMFARTNIENOS� <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY BOFCOMPARTMENTS <br /> tt�r <br /> ❑ PKG1'X PLANT p1bTTANCE TO NEAREST: WELL las FOUNpATION� gEALNv?�t NPTY <br /> ❑ LIFTSTATION 512E - TYPEUAA - SAND OIL SEPARATOR(ENCWSF.DSYSTEM) <br /> LEACH LIFE NOFLINES; 3 L6NGTH OF LDIF.S: 4V DMTAK[rvNtwumi WELL1A� FOIMOATgN29_ PROPERTY LIMEyLJ— � <br /> INFLITRATORCHAMBERS: <br /> ❑ FILTER RED LENGTH DEPTH._ FOUNDATION_ PROPERTY IING� -�1 <br /> ❑ MOUNDED WIDD1� I...TK_ DEPM_-- vNrcxf[NN[cP[xTt WELL__ FOUNDATION_ PRMERTY UNE 1" <br /> ❑ SUMP$ W1011l� IY.I'KNPI— DEPM__ O:RANq TJMFAPMT: WELL FOUNDATW PROPERTY UNEP <br /> ❑ DISPOSAL PONDS W`DD'_ LCNOTN_ DEPTH ISTAnc[Tvrvwon WELL FOUNDATION PROPERTY UNE_♦ <br /> SEEPAGE Prt3 R�_ <br /> DIAMFRA OEPTN_j�?15 J O ONwdT: WELL FOUNDATION SQ, PROPERTY LINEI�i <br /> I HFERRY CERTIFY THAT I HAVE PRCOUNTYARBDTHIS APMJCATION ANDTHE WORK WILL RE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES 81'ATT.LAWS C <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM HNOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE.CALL(709)4647AS] NC <br /> SIGNED: TITLE:4W4// DATE: <br /> j 1 tii <br /> J <br /> 4-1 <br /> � G <br /> I <br /> 1 I 1 <br /> { 4:1 .. <br /> ----'(rte- .t '^I 1-+ - l - 7�IADI�NC1N <br /> H TM-i.. _i-.,_.. <br /> AMLKATNIN ACCk. Bl'. - --RF'-^sP�- —DATE� AAEA GN��EMPWYEF.ID—��Mb1RNT IgCATgA� <br /> INBPECIEO DY:_ DATE:. 6 zY-bY�FERMITPINAL� YES DATE4-z`•rF,.'J�^SPECTq[ _ <br /> ' NMMENTE: _ <br /> nRH RECENFD TE 73oP-2-5 <br /> PEDD ECM aMT PY <br /> 210 115 1$d Sfeo <br /> R <br />