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B-07-202 10:4.3AM FROP P. 2 <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HFALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304F WEBER AVF_,3"^FLOOR.STOC:KTON,CA 75202 (209)468-3420 <br /> y� NON-REFUNDABLE PERMIT EXPIRPS I,Y,E'AR FROM DATE LSSUSD <br /> 108 ADORE S$ 172L>40 C . �j <br /> J - <br /> CITYlIIP r .. _ 1 PARCEL SVYJAPN___1�b[,y <br /> t^% - �Q ! ADDRESS ' 3 f G I,G C.T` ( VN' c <br /> QWNPR I,_f NAME�Cl1��141�C] ,} YY1� � +" �' '• <br /> Cfl'Y21P PHONE __.,Y <br /> CONTRACTOR_..._.. ADMES!% <br /> CITY2m PHONE <br /> GEOGRAPHICAL INFON:RMATIOCOORDIANIES: % {, Y_,. 71>WNSXIPRAN(iCSFITION <br /> PEACTFST(S) VKHOW MANY APPUCATTONA _ <br /> TYPE OF SEPfIC WORK: ❑ NEWINSTALLA"fiON ❑ RF.PAIRIAOOITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE ❑RESIDENCE ❑COMMERICTAL 0OTHER <br /> NUMBER OF LIVING UNITS._„•_•_ NUMBER OF BEDROOMS!_ NUMBEROFrl_OYEE$: <br /> CHARACTEROFSOB.TOAUPP 010 3Fr:ET- PIYISUMPSOILCHARACTER: WATER TABLE DEPTH_ <br /> ❑SEPOCTANKA;REASE TRAP TYPEIMFG_,_,_- CAPACITY NUMBER OF COMPARTMF7JiS <br /> ❑PKGTRFATMENTI'IANT DISTANCE TO NEAREST: WEIJ.__ FOUNDATION PROPERTY LINE___,_,,,Y4_. <br /> O LIFT STATION SIZE TYPE OF PUMP SAND OILSFPARA1'(1R(F,NCLOSED SYSTEM) <br /> ❑LEACHINGLINE NUMBER&LENGTH OF LINES / INFII.TRATORCHAMRERS <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑Flu[EK BLU WIDTH LENGTH DE!"DI <br /> DISTANCE TO NEAREST' WhLl. FOUNDATION: PROPERTYLINE _..-- <br /> ❑MOUNDED WIDTH _ LENGTH DEPTH f <br /> DISTANCE'IONEAREST: WELL FOUNDATION PROPERTY LINE (� - <br /> ❑SEEPAGE PTIS WIDT11 LENGTH DEPTH PAYMENT <br /> DISTANCE TO NEAKEST: WILL FOUNDATION PROPERTY LINE_ _ ECEIVED <br /> ❑SUNIPS WIDTH LENGTH OFPTH <br /> DLSTANCETONFARFST: WELL FOUNDATION PRCWFJTTYLINE Amigm <br /> ❑DISPOSAL PONLIS WIDTH LENGTH—4_ DI",PI'H _ _ _ - - ---"AN JOAQUIN COUNTY <br /> _-- - PUBLIC HE4LH?SERVICES <br /> --- "-' DISTANCE TO NEAREST: WELL _, FOUNDATION PROPERTY LINE WTAI HEAII'HD )f: <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE:W ITIi SAN JOAQUIN COUNTY <br /> ORDIANCRS,STATES LAWS,AN ES�ALVjD_REGULAAT..IIONS OPSAN JOAQUIN COUNTY. <br /> SIGNED: �-� 1YY��I�K. T17LE;_ty:L. DATE: <br /> L'.1lRR'Y 'bM <br /> —4 <br /> Y.YYe <br /> f l e9^01115 0091M _ <br /> I XtOm I <br /> 1 <br /> rAAGFL 9 <br /> A A ML oleo-ate <br /> Fc-,� "? Sa71 <br />