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LIQUID WASTE PERMIT <br /> SAN MAQUIN COUNTY PU}1LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> M4 E.W ESER A Vf;'F(O0R..NTOCKTON,CA 95202(209)4AR-3a20 <br /> 05�d M1ON-REPUNDA8LF.PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS,,.„_1 S.(/� Q� C,t✓� ��1 ^.;..._. APN , 1 \.+1p.)� PARCEk SIZE: <br /> CITYIZIPZre^C..Y1 ..�s�JrBU1LDIV(:PCRMII'a <br /> OWNER NAME_ <br /> .._. t�L1h1� �• `��-- 1MDRF.CS _..L�S�J �:��CIC"1�� <br /> CITY'IZIP_. PHO\F.NUMBER - <br /> CON'{'RACTO/H� � [`�y�.t{� . C�(�:,� ADDRESS -Jy <br /> CITY17,1 P..- V .�+"^�.w_' l �6.E.J <br /> PHONE NUM BF,R <br /> GEOGRAPHICAL INFORMATION: COORDINAYLS.X_ ..�Y_._ ._ 70WT'SHIP -RANGE., SECTION - <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE; NUMBER OF LIVING UNITS: <br /> Cl NEW INSTAL[.ATION O RESIDENCE <br /> NUMBER OF BEDROOMS.” <br /> RF'PAIRlAll01'TlUN )f COMMERCIAL `-.— <br /> J DESTRUCTION ❑ OTHHR YUMBEROF EMPLOYEES: _ <br /> ❑ FNGINEWEVALTERNATiV6 �t G <br /> CHARACTER OF SOIL TO DEPTH Oil 31._5Q Y 45..l PIT7SUMP SOII��L.CHARAICTF,R! _WATER TABLE DEPTIJ;>70 <br /> PERC T&ST(S) HOW MANY_...._—,........_ APPLICATION k_,0 Z. <br /> ❑ SEPTIC TANK TYPEMTFG_-_ ff CAPACITY_.___ _...., AOFCOMPARTMENTS <br /> ❑ GREASETRAP TVPF:MFG C'APAC'ITY,- WOFCOMPARTMF,NTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST! WELT, FOUNDATION_-_ PROPERTY IINF <br /> ❑ LIPTSTATION SCZE - TYPE DP PLVP _ _ SAND OR,SEPARATOR CENCLOSEO SYSTEM) <br /> ❑ LEAC HI LINE, N OF LINES: LENGTH OF LINES:___ OISTANCE TO NKARC4r: WELL FOUNDATION PROPERTY UNE <br /> INFIATRATORCIHAMBERS: 1 <br /> ❑ FILTERBED WIDTH _ LE.NG'I'H. DEPTH MF CLTVNEARur. WELL FOUNDATION PROPERTY UNE ` <br /> ❑ SIOUYDF"D WIDTH l.F.NGTH, DEPTH__ nl.RwhaYiV*FARCE: WELL__ FCAINUATION__ PROPERTY UNE__ <br /> ❑ SCMPS WIDTH LENGTH DCPTII___ DISTANCF,TOMCMV.T: WNI,L. FOUNDAIION PROPERTY LIVE_ _ <br /> ❑ DISPOSAL PONDS WIDTH LENOTII DEPTH__ DL %T CTONII R 7: WFj,L. FOUNDATION PROPERTY LINE <br /> ❑ SP-EPACP PITS p DIAAIHTER DEPTH_ DCITAYCETO NKARM; WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED,THIS APPLK:ATSON AND THE WQRy:WISd,RF,D0,4E IN ACCORDANCE WTTH SAN IOAQUIN LOUITY ORDINANCES,STATE LAWS <br /> AND RUI.&S ANU RE(UI.ATIONS OF SAN JOAQUIN COUNTY. �\1 <br /> N! HO R VANCE NOTICE REQUIREDFOR INSPECTIONS,-PLEASE CALL JZN)08.3423 <br /> SIGNED; <br /> • �.,..._. Warn ..,�--_-: 1:....t.-'- <br /> I / t <br /> .P4 <br /> ,.... .. . <br /> . r areN� f` ►+la � <br /> • � I �1 � tFal _ .�ii, r 11iI <br /> DEPARTMF,NT 77SK oprLy / / <br /> APPLICATION ACCEPTED AY: UAI E r G (] IA 2C EMI1LOYfiE ID.. )lSTA1CT 1, LOCAT40N�C/ <br /> Iry'SPECTWD BY i '1T"T I)A'1'k J1 Y PERMIT FINAI. YESGATE: //�iUY,INSP-TOIL. _ LJ <br /> �'CIMMFNTC: 1 /_.. <br /> PECVDE wINflu AMW;N'T CHF[Kx H RECEIVED DAI I: PeIEMITdF.RVK'E RPOLf$'fV INVOIC'EP SEPTIC'IW <br /> iFMiTTED <br /> By <br /> i�Z22 521 q-9 115Do C8 faz "S�a� v`(, <br />