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LIQUID WASTE PERMIT <br /> SAN J OAQUIN MUM PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> W 30iE.WEBERAVE3N`FLCOILSTOCKT0N.CA 95I41231091ARF3420 <br /> NON•REFUNDABLL PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESSN4P _ APN /9�06'O —Q� PARCELSI", <br /> CRY/LIP� N4 MIMING PERMIT <br /> la Tslr/x,*' „ .ar �7J_ <br /> OYMFB NAME nyly� ADDADDRESS277 \ / /•� —/O <br /> m. vmr "FFA//({� PHONE NUMBER= 3 <br /> CONTRACTOR ADDREM <br /> CITY= PHONE NUMBER <br /> GEOGRAPHICALINFORMATION: CTKRLUINATE9', X Y .,,,,,__TOWNSIIP_RANOE_SECOON__ <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBEROF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑)I REPAIWADDTTION O COMMERCIAL <br /> DNUMBEROF EM1IPLOYEP6: <br /> DESTRUCTION O OTHER <br /> ENOINEEREDIALTERNATIV6 <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: —WATER TABLE DEPTH: <br /> ❑ PRRC TMY(S) HOWMANY APPLICATION* <br /> Cl 9EPTICTANK TYPEIMFG CAPACITY IOF COMPARTMENTS <br /> ❑ GRFAsETRAP TYPFIMFG CAPACITY *OF COMPARTMENTS <br /> ❑ PK,:i PLANT DIETANCETONEARM; WELL_ FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION size--— TVlEWPWD SAND OII.SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE N OF LINES:_LENGTH OF LINM: D[ AK......; WELL_ FW WATION� PROPERTY LINE_ <br /> INFLITRATORCHAMHERS: <br /> ❑ FILTERBED WIWH— LENGTH_ DEAN__ ONTAIN:[TONEAPVT. WELL_ FWtAATION� PROPERTY LINE_ <br /> ❑ MOLNDED WIDTH_ LENGTH_ DEPTH__ ONTAK[TOn[u[R: WELL FOUNDATION_ PROPERTY LINE_ <br /> ❑ SUMPS WIDN_ LENGTH_ DEPTH_ DOTH MNCAAM: WELL_ FOUTIDATMN_ PROPFITV LINE_ <br /> ❑ DISPOSAL PONDS WIDTH__ LENOHI_ DEM_ omAK[iOxuPui: WILL FWWAT"_ PROPERTY LINE_ <br /> ❑ SEEPAGE PRS p DINMETER_ DEPTH_ DNT rcLTON[ARLR: WELL FOUNDATION_ PROPERTY LINE_ <br /> I HERESY CERTIFY THAT I NAVE PREPARED THIS APPLICATION ANOTHE WORK W IL'6 BC DONE IN ACCORDANCE WITH SAN 90AQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULAT'IONSOFSAN JOAQUIN COUNTY. <br /> TA]{NIMUM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLLEEYASE CALL(209)461-3923 <br /> SIGNED Twp"'_ TITLE:�JQISDATE: �,�� <br /> O <br /> MEEi <br /> ...i <br /> ._i.._i....{.._:...LL R H <br /> H <br /> EN <br /> T- <br /> - <br /> ;... <br /> ...; . ; tt <br /> rE ._ ;.._ <br /> - <br /> �. .._ - <br /> : I _ <br /> . ... ........ <br /> 1 <br /> \IPTEPAZ <br /> ARIKATION ACL4ITFD BY: ` AR[A� PlAYE61p_✓/•�^p(`TM ryLOyC�ATNIN <br /> IH4ERED T: ( J21 DAT S,5 f�PENVTFINSJ� VESDATC�!n IPOP�TT�'J�. <br /> RLSOE iC INFO ANOYNT CMPLU�CA9N AFL lED DATE iNVIRION MPTR,RY <br /> R TrrEo Sr <br /> i <br />