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LIQUID WASTE PERMIT <br /> SAN JOAQUINCOUNTY PUBLIC HEALTI I SERVICES ENV IRONMEN r.AL HEALTH.DIVISION <br /> 3W)1:.WEBER Ava.3R°FLOOR,STOC)CIT)N.CA 932.02 (209)468.9420 <br /> �pNON-REEL/Nb.4RLli PERMIT EXP1Ry 1 YEAR$RC')M DATE lSS`�j+,p �''� �.•��-• <br /> JOB ADDRESS,���A �J J!^a/ �' _� 1 W'!.✓ <br /> CITY,71P�!_ _ + ® --„__—PARC€I..SrrlFlAPN_. �' !/'+�`1 G- �✓G•)`�"" <br /> OWNER NAME/-C (�,(_ �C'.� t��//!O�Z ADDRESS 2_ 34?4P' Zf- - G• <br /> CrrY121P_.7";-i e /�_ �L� <br /> CONTRACTOR- Int,1DWII J'ZKe-!`�7 ADDRESS-✓r7z',-7 <br /> ,/ //�"'✓�`•� <br /> CT17/23P P".1+ A a d/ ^_FHONE.._�..��� <br /> OF(JIGRAPHICALINFORMKRON:COORDIANTFS: X Y TOWNSHIP___RAN(;E_SECfltltN <br /> ?ERC TESTS)/HOWMANY__j________._ APPLICATION u:- IVJ� <br /> TYPE OF5):.P'I'IC WORK: ❑ NEW INSYAL(-ATION ❑ REP.VRIADDTTION ❑ DESTRUCTION - <br /> INSTALLATION WILL SFRvE: ❑Ruwl)ENCE ❑CUM tiIpRICIAI. ❑OTHER <br /> NUMRF'R OF LIVING C'NII:S: NUMBEROFBF.DK0OMS-_ NUMREROFEMPLOYCESL____ <br /> CHARACI'ER OF SOIL TU A 061'TH OF 3 FEET: PIT/SL'MP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> ❑SEPIIC.TANKGREASL TRAY TYP(IMW,_ CAPACITY NUMBER OP COMP.ARTMFN[N <br /> ❑PKG,rREATMEN'T PLANT' DISTANCE TO NEAREST: WELL FOUNDATION- PROPERTY LINE <br /> MLIFI STATION S77_F. TYPr OFI'UMP ._SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENG H OIC LINES 1 INFILTRATOR CHAMBERS <br /> DISTANCE TO NEARPS'1'; WELL ,._FOUNDATION "'ROPERTY LINE <br /> ❑FILTER BED W I UTH LMGTH _ DEPTH <br /> DISTANCE TO NEARFST:WELL . FOUNDATION:_._ PROPERTY LINE_ <br /> ❑MOUNDED WIDTH LENGTH . _DEPTH_ __ r'_Ipti N1 Ef,t; <br /> DISTANCE TO NEAREST: WELL _...._...-FOUNDATION ...... PROPERTY 44f-C'F <br /> ❑SEEPAGE PITS WIDTH_- _- LENGTH _,. _DEPTH <br /> DLSTANCETONLARF:ST: WELL _FOUNDATION PKOPERTY.LINE.�.[". I 'A <br /> ❑SCrMPS WIIYTH_-_— LENGTH DEPTH. _ FAiXJ.JA':b'ri000N-f <br /> tC!IEA'.'tl SEfiulCl"� <br /> DISTANCETONCARMT•. WEI1. _-_ _J•VUND.ITIUN ,..._PR0PRRL•I,Y 1;.�'.:�.._,,.r; <br /> ❑DISPOS AI.PONDS WIDT7i __ LENGTH DEPTII_ <br /> DISTANCETONMAREST. WEI.L --FOUNDATION_ PROPERTYUNIT— <br /> I HEREBY CRRTIFY'PRAT 184VE PREPARED THIS APPLIC'ATIO,N AND THE WORK WILL BE DONE M ACCORDANCE.WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,S TE LAWS.AND RULES AND RfGULATIO_NS OF SAN JOAQUIN COLN IN- <br /> TL <br /> SIGNED- _qtr-�•�.s�..+' 4 .- :�"4•'r✓, TIR:S.et ;�/71�w:�' DA'1'li: �?��/'G <br /> y a SA JOf <br /> ��77 Al\N"C2,pi IEA N <br /> Nf - <br /> m_ <br /> wjrl <br /> go C� i <br /> Is�uCll•ro VC/ - � I <br /> 1 IR J✓�— <br /> u¢PA s 'r U.sEONLY <br /> APPIACATIONACCEPT6DDY: <br /> TANK.PIT.OR SUMP INSPECTED BY:.. <br /> i7NAL INSPECTION D Y _ <br /> f.OMh]ENT r ..__ <br /> PECODF 9C AMOUNTRECEIVI'I)BY I DA I sEPTIC a)# <br /> � ?__ IhTrI P.CKw CIT197 _ <br />