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LIQUID WASTE PERMIT ` <br /> 'f - ! 4 SAN JOAQUN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION' <br /> 300 E.%NTSEK AVE 3"'FLOOR,STOCRTON,CA 9SZr,(209)W-1430 <br /> ��tt _ / ,.eAEFUNDARL PERMIT EX PIKES I YEAR FROM DATE ISSUED ♦�•-• <br /> 108 ADORESS�V�� jGrJf ,Ply/�l,�!'�/�!'J�ji 2�, <br /> APNPARCEL SIZE: ©• J <br /> C}TVlZIP_ O�jE I/OAA/ !J vH-' BLHAiNGPERMITN <br /> OWNER\AME�C+ ( Ja✓ ADDRESS <br /> CITYfLP ---_. PHONE NUMBER��I <br /> CONTRACTOR � �' s` J'i AD DRESS.. <br /> CITYILIP,� �jg'/ �}'y'�►j f S''-' PHONE NL'MRRR_„��. = �� <br /> GEOCRAPHICALINFORMATION:COORDINATES X Y _TOWNSHIP_-----RANGi: SECnQN <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF UVP%UNITS:—/_ <br /> *�L�iJpt& A4Td8N— X WIDENCL NUMBF,ROF BEDROOMS: Z� <br /> REPAIRIADDITION �[.�J��,�y _ 7� LJ COMMERCIAL <br /> ❑ DESTRUCTION - 1_ •'"y p OTHER NUMBER gFEMPLOYEES: <br /> ❑ EKOINEEREWALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH;__ <br /> ❑ PERC TEST IS) HOW MANY_APPLICATION# <br /> �I SFP77CTANK TYPOWIG_ CA'P.ACITY /1.10 ItOFCOMPARTMENTS <br /> U GREAsr,,mAP TYPFJMFG CAPACITY #OFCOMPARTS4FNTS <br /> O PKGTX PLANT DISTANCE TO'NEARM-. WELL FOUNDATION PROPERTY LINE <br /> 0 LIFT STATION SIZE TYMOPPUMP SAND 011,SEP.A2ATOR(ENCLOSE13 SYSTEM) <br /> LEACH <br /> ` Of / <br /> LINE. #OF LINES; _LENGTH OF LIN'Ea• OIsm"L TOMARM; WELL.,�o FOUNDATION PROPERTY VN <br /> INFUTRATORCILIMBERS: �J <br /> ❑ FILTER BED WIDTH LINo1T1 DEPTH_! AIFFANCEtFINCARIJ•ri WELL= FOUNDATION PROPERTY LIKE N <br /> ❑ MOUNDED VIDTH LISKO H DEPTH TILKTAVCETONAAAF= WELL FOUNDATION PROPERTY LINE_ �> <br /> ❑ SUMPS WIDTH._.__............ LOTH, _�-._ DDTTH omTANCCTONAARP9T: WELL FOUNDATION,_._.__.._.._ PROPERTY LINE <br /> . rn <br /> ❑ DISPOSAi.PONOS WIDTH LeNCTTI DEPTH DMANCYTONLMFAT WELL FOUKDATION PROPERTY LNE <br /> SEEPAGE PITS S OLKMETE'st DEPI'H2l on71NCeTomAm-(; WF.I.t,,�O , FOUNDATION_! PROPERTY LINE <br /> 1 HEREBY CFJCCIFY THATI HAVE PREPARED THISAPPL)CATWN AND T14£WORK WILLRE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONSOF SAN JOAQUIN COUNTY. <br /> MINI 34. 1!ADVANCE_V=E REQUIRED FOR 2NSPECTIONS—PLEASE CALL.(204)469.3423 <br /> SIGNED: <br /> TITLE!I..��l, DATE: <br /> I , <br /> ... 444 <br /> _ <br /> I I `U a l <br /> 4. <br /> �y RE <br /> FI7({W��'F <br /> ---t---F”'-h- �'�3 ��• _ _ ' .1 -J. � 1 � I t--•.I,. I ..F, v-•--Y— <br /> 1 <br /> } t i. <br /> I <br /> DEPARTMENT NI.Y �//ffryry ��� ��.eeecJJ//ff!!__ f+ <br /> APPLICATION ACCCWTEII BY, _ _:3AT'E: EP'Z-AAW�EMPLOYEE IDF_� STRICT!LOGTION L1 <br /> INSPCCTEDBY: ,,,,_,_ _DATE_I`r3'"�A�+PERMITFINALO YES DATE:_ INSPECTOR:. <br /> _--. <br /> coNL*IENrs; Ci n•✓7 2 30 A1 ltl7j�5cy' 62,t_9`(3•n 2 A oR <br /> FEroDP. SCI o IfNTCI AttSt4t1 AACEFYFI) DATE RMrr1$LRVICEREOIieS'T/• LNvu1CFI �ePTlC1D- <br /> PEM eY <br /> f l�tj I $hoc 2/ <br /> IdViEtt4iI1F11 <br /> 1 <br />