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LIQUID WASTE PERMIT <br /> SAN ILJAQ 1�F.N wDU ER AVBsIi° n HEOOR FLOOR. CA 19521y2 ENT <br /> [209)A BL3 20 TH D1'^� _f 'r <br /> NO E NDARI.F. ER_YHT EXPI FII YEAR OM A I ISSUED --�:••y.-� <br /> 17P ADlxiF55 33 2 3 3 oI r oS <br /> CIT71ZLP_, L, Ll I <br /> PARCEL S1Zi.:lAl'!+[ r - _— <br /> OWNEI.NAM <br /> CITY/ZIP--. �•L•'-+"-i r�Jn'��`(' <br /> CONTRACTOR 6�(67-7�/.�CI Qi',(ATb A) .,ADDRESS 6.1 7 <br /> C]TYf/11'_ f �J4 7 3e -' PHONE <br /> GFIX;R,APHICAL INFORMATION:COORDIANTES' X_ .Y 'In%VNSHIP—RAYGE_SE10-ION__ <br /> PERC TEST(S)f )NOW MANY" APPLICATION M:_ <br /> TYPE OF SY.111'LC WORK: NRW'INSTALLATION ❑ REPAIRIADDITION ❑ DESTRUC:nCN <br /> INSIALLA 110N WILL SERVE:: ❑RESIDENCE ❑CDNIMERIC:IAL OTHER i4A 1'��'� <br /> NUMBERQVIJVINCi1:NTS: v NI 1.14HER OF HEDROOMS'-&- NUMBER OF EMPLOYEES: 4 4 / <br /> CHARACTER OF SOIL 10 A DEPT H OF 3 FFE7: PITISCM P SOIL CHARACYFR; _ WATER-TABLE DEPTH I l- <br /> ❑SEPTICTANK/L;RFA,t.TICAP TYPFJVSFG �(:I'TY�.>UMBEROFCOMPARTME.NTS 2 <br /> ❑PKG TREATMLNT PLANT' DISTANCE TO NLARFS1'. WE H'OL'NnAT1A 5 PROPERTY LINE �� '.. <br /> El LIFT STATION SIZE - TYPE OF PUMP SAKD OIL SEPARATOR(ENCLOSED SYSTIiM) <br /> ❑LEACHING LINE NUMBI:'-R&L.ENC',THOFLiNES---_—f« _ INF1I:1'RATOR CHAMBERS <br /> /DISI'.ANCETONFARFS/ WCIA._ —FOUNDA'1'IO.V _-R(]I'ERTYLINF <br /> *ILTER BED WIDTH -`' LENGTH11071``1 orDISTANCY'!'0 NEAREST:WEL> FOt)NDATIOK:�S-_PROPERIV LIME>/Ca <br /> D AlO!)NUEU w}DTH I.H)V(j'1'N .. DpVM <br /> Df.STANCFT,)NEAREST: WELL FY)UNDATION �—PROPERTY 1•IMNY-ME41, <br /> { <br /> d NEFPAGE PITS WIDTH I.CN(i171_.. ___DEPTH FlECF!VU' <br /> DISTANCETUNRARFn 1: WELL FOLINUATION PROPERTY LINE <br /> ❑SUMPS WI))'I'H LENGTH UT:]'I'H •i" v .7 (L,� ' <br /> DISI'.ANCETONEAREST: WELL �_.,_F'UUNDATION'_ PROPERTy _ NIV <br /> 13 DISPOSAL PONDS w11Y1'11 LENGTH PUBLIC IiFAI TI i 5ERV;;CF$ ` 14 <br /> —.--._ DGl"fM_ -- Ft:;13(1';L7�NT.:1'fF41TF�l?It;rt�. Vv <br /> D1S'FANf:E TO NEAREST. WELL _FOVNDATIOK __PROPERTY LIN2 V� <br /> I HEREBY CERTIFY THAT I HAVE.PREPARED nlIS APPI.ICATIQN ANDTHE WORK W'11.1,RR DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCEN,STATE:I, WSJ BUJ.," NO REGULATIONS OFSANJOAQTAN COUNTY. <br /> SIGNED:- ti / _ <br /> .. .__ TIT1.F:: � e- �.._,.. YDATF.: <br /> I lca'�" IEfnRA7P.{� ' n <br /> ow <br /> vi ro ,r <br /> vi <br /> Ogg \ <br /> i — r ao' '(ICxlPE I.wc <br /> o <br /> Sfena.J <br /> -- F1drCr <br /> op, -- <br /> -h4 �f 4_ ,dS f3ulc.r <br /> S�;Op 9677 <br /> I, 33233 s Kosra,'l � <br /> � !'7"'� �(K-NT (., ] <br /> APPLLCATLPN ACCEnr-D BY: L fl_ F�1 <br /> _HATE: . <br /> T'AN'K,PTT,OR SOMP INSPS(TED BY: <br /> .DATE:_ V <br /> FINAL INSPFCTIpN BY <br /> PE CODE SC AMOUNT CHy A.1 REI,GVED BY DATE 1'P.RM(C/SEKVICL REQUEST SEPTIC IDI <br /> INN; Rr.MITTF. CASII <br /> al �fS 180 ': 19G S o�zSS <br /> C �g -3Z3 sp-eCf <br />