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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COLTl'1'Y PUALIC HtAI.T8 SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E•WRIER AVE 3'"FLOOR,MW.KTO".CA 95242 1209)46N-J420 <br /> f��.(��7 N 'wREFUNDABIFPFRMITEXPiRE/S��fj],�.A�R FR M �] )1wSU`i,Ql <br /> JOBADMUE�S�S�=-1,L/ 7 5 sae 952a-- - <br /> ��•Jryry2 0.P'VLJ yf I l V ^V, PARCEL S(ZE: <br /> l'ITY/71P 11,i��,,�VAJ�AJ}��/Mj—j�rr+'� + BL'11.D1N(:PPEER/��MJIITT/X5- <br /> OWNER <br /> `y►�'' <br /> OWNER NAME.;1�1,M2F,+_�v� �C� /^. ADORE"AT-A''7���- <br /> CITY/ZIP13 1�^.-^,J� �.__,•.S ��__ ��n~ PHONE NUMBP.� �'` �`� Jl <br /> CONTRACTO�RaI4'o,"� S ADDRESS A 'v' W•� r_ <br /> C.ITVrZIP C G...I"� P170YE NUMBER <br /> CEOGRAPHICAL INFORMATION:COORDINATES.%__ _,Y._ <br /> TYPNOP SEPTIC WORK: INSTAI.LATIO'i.WILL SERVE; NUMSEROF LIVING UNITS: <br /> 0 NEW INSTALLATION W RE;SIOENCE NUMBER OF BEDROOMS: <br /> X REPAIR,IADDITION Q COMMERCIAL <br /> NUM6ER OF EMPLOYEES: <br /> O DESTRUCTION ❑ OTHER ,__ <br /> Q 6NoiNFLREixALTF,RNATIVL <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: __WATER TABLE DEPTH: <br /> -70I <br /> 0 PFRC TEST IS) HOW MANY APPLICATION <br /> ' ❑ SEPTIC TANK TYPR.MIFGCAPACITY P OP COMPARTMEN'T'S...—�__ <br /> i <br /> S7 ORJ;ASETRAP TYPti'MK,_ _ CAPACITY_ #OFCOMPARTMEMS <br /> ❑ PKGTX PLANT DISTANCE TO NF.ARP.ST: WELL FOI:NDATION_ — PROPERTY LINE <br /> ❑ LIFTSTATION S(Z@_ TVPF OP InWP^`___ SAND OIL SEPARATOR(ENCLOSED SYSTEM)—__._.___� , <br /> i <br /> j ❑ LEACH LINE 4 O LINES:jLENGTHQFlJNES:_D � <br /> D6T+tNCR 70NG7tPaTt WEI1T POUNDATION35* PROPERTY LINE_�� <br /> INFLITRATOR CHAMBERS: 1Q.— <br /> ❑ FILTER BED W'lUTll'— Lf.NOT'H UfvTll DMANCE TO neARecr. WELL FOUNDA710N—__,_,_, PROPERTY <br /> ❑ YIOUNUP,D WIDTIILFNCTSI__ UEPTH" aIETANrs vn HfnwfPT: WELL_–-__ FOUNDATION`— PRAPERTV LINE <br /> t (] SUMPS WSOTH LENC17F1,_,_ DEPTH DIATANCf TO NEMttISi: WPl,t FOUNDATtON PROYEATY LINE,__ <br /> f <br /> 0 DISPOSAL PONDS WIDTH LENGTH__ DEPTR__-`___ vwANcf roxrAv 'if WELL__,_ FOUNDATION PROPERTY LINE <br /> 7, <br /> SEEPAGE PITS X.�-..«-_- OfAMElEa '_ DEPTH,�,�;, ➢I:rrAncf 7o tE�Y[Rr: W'EI.LI�Qt f-0UVDATKIN PROPERTY LINE-20+ <br /> I <br /> I UEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BY,DONE I.N ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAMS <br /> AND RULES AND.REGULATIONS OF SAN JOAQUIN WUNTY, v <br /> INT 24HOUR.ADVANCENOTICE REQUIRED FOR iNSPECTIONS- t.E ti CAL 68 <br /> (709)9 -34]3 <br /> L� _I1TLDATF�L.l.ot- .-___ <br /> .1. T. ..j. +. ,' . . .....,_._ <br /> • <br /> (.. ..i. .,Z. .! -y. .4..J. I _7 ..-. . _ ._. t 'I' '.:ft•i�p.,I.,{rr •h, rrwi�� <br /> M <br /> i � '. TY'^Df f:PART�N'11•:1►�(�U{7 0-2 <br /> APPLICATION ACCO to BY' ,liC/ _�� DATE c jyt�EA f l EMPLUVEE IW. LOCATION4 <br /> INSPWTED ./yam•%„Zh rZ,��____DATL•:_� +' __PERMIT FIMAIT:,U Y�EyS OA '"'�O+!_yI ,_ <br /> COMMENTS CSI-.r—; '.�T_ � T�--«"') _cry" /��GG/S �i�L.l�� .•GcSK—.'.� � <br /> t <br /> I'£fpUE EC nalo AMOt/NrNEr.'' au nctIvE'D DATE PERIAMSFIIVICE REOIIE" IN'VO1C'J:M SEPTIC Ipf <br /> ABMIMD BY <br /> �4t <br />