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LIQUID WASTE PERMIT t► FSR rYc�rr <br /> SANJOAQCINCOUNTY <br /> PUBLIC SERVICES <br /> FiROUMEM ) Ili DIVISION <br /> 30E.WD A [3"DR.ST(IC KTONCAOW� <br /> NOV-REflN ABI PERMIT R53 WAR FROM DATE ISSUED <br /> d fN F�Lv fo <br /> • JOB ADDRESS _ _ -T - <br /> CITYZP _ PARCEL51'LWAIM <br /> OWNER NAM <br /> �AD(OAFS �.G•M <br /> CITYZP I ) LHON <br /> CUn'IAACIUR ✓V _ADDRFSB d >�' . <br /> CITYZP�!����-��PHONE <br /> GEOGRAPHICAL INFORMATION:COOR(JIANTES: X_Y_TOWNSHIP_RAN'Oli_SECIION_ <br /> PERCTTST(S)( I HOWMANY �,/ APPLICATIONr <br /> TYPEOFSEPIICWORK: ❑ N'EWINSTALUTION CPAIRIADDMON ❑ OESTRN'nQN <br /> tNSTAU.ATIONWILLSERVE: ❑RESIDENCE %COMMERICIAL 13 OTHER <br /> NUMBEROFIIVINGUNII3:_ NUMBEROFDCDROOMS:_ NUMBER OPEA1PIAYXVI:___ <br /> C.HARAC. OF SOIL TO A DEPTH OF]FEET. ,_ PITISUMP SOIL CI IAKACTER: WATERTABLEDEPTH_ <br /> ❑SEPTIC TAN IUGHEASP.'IRAP TYPYIMIU „CAPACITY NUMBER OP COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCETONFAREST: WELL_ IOUNDATION_ PROPEJITYIJIKE <br /> ❑I�JPTSTATION 5(?F TYPHOYPUMP SAND OIL,SEPAMTOR(fiNCLOStU SYSTFMI <br /> LPLFACHRSG LINE NT:MBER&LENGTHOFLINFS�I� / INHI.TRAT��(R.'//ORCCHHA....,M, BB ,I[ <br /> DISTANCE IU NEARM: WKI JJ IL� ,FOUNDATI -- _^ROPFRTY LINT <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCF.TO NFAREST:WELL___ FOUNDATION:__PROPERTYLINE <br /> 13 MOUNDED WIDTH LENGTH DEPTH <br /> LJ( DLSTANCF.TON'AVIS'1) WELL FOUNOATION PROPERTY UNE <br /> EEPAGE PITS WIDTH- ✓� LENGTH-- T- <br /> DER... <br /> DISK•"RHTp NW+F4T. WELL --- -FOUNDATION PROPERIWUNE <br /> ❑SUMPS WIDTH' ILKOgY .-DEPTH_. <br /> D11OANCE'I'ON1.dPSP: WVJ, .. ..-_FDINDA70K PROPERTY LINE <br /> ❑DISPOSALPONDS WIDTH LENGTH DEPDI__ <br /> DI�TANCEM NEAREST: WELL _ FOUNDATION _PROPERTY LINE <br /> I HERESY OER"FYTHAT I HAVE PREP THIS APPLICATION AND THE WORK WILL UP DONE INACCORDANCE WITH SAN fOAQQ COUNTY <br /> ORDIANCFSSvr.JAW,A.DRUi. DRF.GCIATIONS OF SANJOAQON COUNTY. 1'etL <br /> SIGN'IiD: TITLE:_ _DATE <br /> On <br /> efl <br /> .. .. <br /> /116 <br /> 4 zi <br /> Ii <br /> MRDEPARTMENIJdEDNLY u��, to// <br /> APP(JCATIORSVMPIIFN _DATE <br /> TAKK.P?.OR SVNP INSPFY'ItD _ _ DATEV <br /> 10-094 <br /> FINAL MSPFCDON BYyhwo <br /> cmxMlrYS: F'-'tt. ..L/�i. •�' L.O._ — . _ iATdi1 /�,e <br /> 6°� Cie'• u�PC4tly s f?Yi A d�rf %'ore d fNJf �df n /� /Jr�ddA` <br /> • PECDDF. 5f A..:\T CNFL.KM Ft[:MVN)NY DATE PoRNRRLRVICE ACWEST♦ 5EY1'M.IUS <br /> 1 2. a5 <br /> ,�Arll AiIti L R4V 0,04 K /Au f . ✓ !J-O/ 04' <br /> aec°ry +✓4TnA /.Jv. 1N3•t/•o<r— <br />