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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH uP2VH F4 rsAC)-FiC)EE <br /> 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 (209)468-3420 �:9 - - -E <br /> ED <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DA'Z'E ISSUED 'ted <br /> JOB ADDRESS <br /> 54.0 5, i n-o R <br /> `� N S <br /> CI.-TY/ZIP SAO C,1F-To 1 �52i15 PARCEL�SIZ.E/APN '70 L + <br /> OWNER NAME �>✓2L1N�777N Alo2Ti#�REJI4NTI A DDRESS� <br /> I LA.-Ar Ga. R <br /> icayrapmEw, <br /> ....._ .,.. PHONE <br /> �_r � <br /> CONTRACTOR Cd � S�' ltG D __ _ � y � ADDRESS f <br /> CITYIZIP PHONE <br /> cs- <br /> 0368142 21510 <br /> GEOGRAPHICAL.INFORMATION.: COORDIANTES: X Y TO NSHIP RANGE SECTION k <br /> PERC TEST(S) ( ) HOW MANY APPLICATION#: -` <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION <br /> 13DESTRUCTION: <br /> INSTALLATION WILL SERVE: ❑RESIDENCE19( <br /> C OMMERICIAL 0 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF MPLCSYEES� <br /> ir t. <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH z <br /> �iSEP i IC TANK/GREASE TRAP TYPEJMFG L 1a L !" CAPACITY 2 �o ' ' NUMBER OF COMPARTMENTS <br /> �'_. <br /> 11PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE S,f , <br /> F2 <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACHING LINE• <br /> -NUMBER&'LENGTH OF LINESl 1�0''t' INFILTRATOR CHAMBERS <br /> r s ;W ir{ '�, id :•)r- t; .::# f Y'31 s -• ., ... .. r:; �"+ str !, .'•. }., � ' :, , ., s,; .�, r �•. " ' <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE r <br /> yFILTER BED WIDTH S LENGTH 40 DEPTH "a <br /> # .r �c <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE k <br /> ❑MOUNDED WIDTH LENGTH DEPTH T <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE Y <br /> ►SEEPAGE PITS WIDTH b 21 LENGTH _ DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ` <br /> ❑SUINIPS WIDTH -LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br />