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LIQUID WASTE PERMIT <br /> SAN IOAQUIN 001'NTY PCBLIC HEALTH SERVICES ENVIRON.%fF:NTAI.HEALTH DIVISION <br /> 104 E.WEBFT2 AVI'..,3"1•I.00R,ST(X KTC)N.CA 95202 (209)•J68.1410 <br /> J 1QN,REFUNDABLE PERMIT EYMRES I YEAR FROM DATE ISSUED ��� --5 f <br /> 1011 ADDREss.- J '�- / r <br /> CITY!/1P L-Oµ. ' PARCEL SIZEJAPN <br /> OWNER NAME C JY L NT.^�O y7 (� T, �i;` tC•;,��`� <br /> C1TYfL1P-giSlAp �3 Art 0 4' PHONF. '7 e --,37;f fL__ <br /> (,o.NTRACfIUR /17/I,t P`�t/-1bne ADDRESS 215'09 <br /> Q <br /> CITYM zol d CS/o 7 S J S —PHONE J•Sl- o'f 3%� <br /> OEOURAPffICALINPORMATION:COORDI.ANTES: X__Y__TOWNS111P_ RANGE—SEcnON <br /> 4 FERC T(STrS)( 1 HOW MANY Y _ APPLICATION M: <br /> II TYPE OF SSMC WORK: ❑ NEW INSTALLATION W RLPAIR/.ADDJ770N ❑ DESTRUCTION — <br /> IINSTALLATION WILL SERVE: XRESIUENCH. ❑COMMERICIAL ❑OTHER_— _ <br /> 11!MBER OF J-(L'(NG IJNlT5: NIJMJIER OF BEDROOMS'3 NUMBER OF EMPLOYEES:��._ <br /> C'HARACfER OF SOILTO O A DEPTH OF J FL•FT:— P(T/SUMP SOIL CHARACTER, — WATER TABLE DEPTH <br /> D SEPT'JC_'TANK/(;RLA.SE TRAP TYPFJMRO CAPACITY `NUMBER OF COMPARTMENTS_ <br /> ❑PKG TREATTMENT PLANT DISTANCE IO NEARREES``T: WftLLFOUNDATION PROPERTY LINE _ <br /> E]LIFTSTATION SIZE---___ TYPE OF PUM 1. SAND OIL SFPARATOWC1.OSED SYSTEM) <br /> )VACHINGLINF. NUMBER&LENGTHOFUNES !— Il1C 1A / INFILTRATOR CHAM8ER5 <br /> _ 1 E r`) <br /> DISTANCETONEARE.ST: WELL FOINDATION--lam. — 4P.OI'EkTy LfNE _ <br /> I` ❑FILTER BED WIDTH LENC7H—_— DEPTH_ � ,,J)� <br /> ` DISTANCE TO NEARI._ST.WELL - FOUNDAT(ON:_ -!'POPER1PAV y�'6U <br /> 0 MOUNDED WIDTTJ LEN(iT'H_ DF'.PTH RECENED <br /> 4 DISTANCT TO NEARIENT: WELL FOUNDATION._ PROPIWE J <br /> 4 ❑SEEPAGE PETS WIDTH- LF.NOTII„_DEPTH _ 71 <br /> DISTANCU'TONLARETT.- WELL FOUNDATION .� __PROPI$wj4vAE1u'N(x)I.IN7Y <br /> ❑SuNws WIDTH LENGTH UEPTIIPUBLIC HEALTH SCRWES <br /> ENVIRONMENN rIFALTH DIVI910N <br /> DISTANCE TONEARFST: WELL _ R)UNDATION PROPERTY LIKE_._._ <br /> ❑DISPOSAL PONDS WfD'IN__ LENGTH_ DEPTH -_ <br /> DISTANCE TO NEAREST: WELL —.__ FOUND.ATION PROPFJIT'YI.INE <br /> U HEREBY CERTIFY'PHAT I HAVE PREPARED TIIJS APPLICATION AND THY.WORK WILL BE DOFF.IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> DRDIANCS ATELAI ,ANDRU.E.S REGULATIONS OF SAN JOAQLIN COUNTY. /'Ia/"r9ar <br /> SIGNED: T(TLU:��'` DAT,: -3--- <br /> I i I <br /> i ? r <br /> I <br /> It <br /> —�— ^ ,•1'OR f1F.PL'SS ONLY <br /> APPLIc'ATION ACCi.PTEU RY:_ !`(., a�(���'�`J' `�'�"•_(!v —pATL': <br /> 'rlvxC Ptl.OR 5 UMP IN'SFM.M—D BY: <br /> FINAL INSPFLTION <br /> ..-- <br /> COMMON i's:_ <br /> PE LODE S(- AMOUNT CRECKR/ Rk.L:LIYb1)BY DATE PERMITZERVICEREQLT-51* SFYnC mo <br /> _ INFO R6�4 7EU— C'.as <br /> -- <br />