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TlI ?,,,_, <br /> LIQUID WASTE PERMIT <br /> SAN lOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> Iy 304 E.WEBER A VE.,3 FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> f N-REF N F T EXP R <br /> 106 ADDRESS I E M DATE ISS D <br /> CiTYIZI P � f. <br /> {r' PARCEL SIZFJAPN. E, <br /> M`} OWNER NAME <br /> ADDRESS <br /> CITY(LIP - I L Al <br /> CONTRACTOR O [- PHONE <br /> k ` ADDRESS bD 5 <br /> D E} <br /> PHONEF Y TOWNSHIP"RANGE_�SECTION <br /> GEOGRAPHICAL INFORMATION: COORDIANTE& X PERC TEST{S) { ? HOW MANY ` <br /> TYPE OF SEPTIC WORK: APPLICATION p: <br /> INSTALLATION WILL SERVE; <br /> NEW INSTALLATION 13REPAIR/ADDITION <br /> { ❑RESIDENCE ❑ DESTRUCTION <br /> F [3 COMMERICIAL <br /> NUMBER OF LIVING UNITS; []OTHER <br /> NUMBER OF BEDROOMS: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET,,, NUMBER OF EMPLOYEES: <br /> 13SEPTIC TANK/GREASE TRAP PIT/SUMP SOIL CHARACTER: <br /> I 1 P TYPFIMF G WATER TABLE DEPTH <br /> j O PKG TREATMENT PLAN CAPACITY NUMBER OF COMPARTMENTS_` <br /> DISTANCE TO NEAREST: WELL <br /> El LIFT STATION SIZE—�� TYPE OF PUMP FOUNDATION PROPERTY LINE <br /> r ; <br /> t <br /> �❑LEACHING LINE NUMBER&LENGTH OF LINES SAND OIL SEPARATOR(ENCLOSED SYSTEM) ~ <br /> J 4 / U C INFILTRATOR CHAMBERS <br /> DISTANCE TO IyEgaT: WELL3jJQ <br /> ❑FILTER BED r' FOUNDATION �G3 0 <br /> r, ;,,i WIDTH� LENGTH ` pR <br /> EPTHOPERTY LINE <br /> k 1 �_ <br /> F DISTANCE TO NEAREST: WELL <br /> P MOUNDED WIDTH . � FOUNDATIONr PROPERTY LINE <br /> LENGTH �^ <br /> DEPTH �� f <br /> DISTANCE TO NEAREST: WELL <br /> 0 SEEPAGE PITS WIDTH FOUNDATION _ PROPERTY LINE J <br /> LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION <br /> SUhIPS WIDTH ` LENGTH /� / <br /> M � _�� PROPERTY`LINE`�� <br /> �`-�'�� DEPTH I4 <br /> 4 <br /> ° DISTANCE TO NSARF,ST: WELJ <br /> DISPOSAL PONDS WIDTH -�FOUNpATION� LENGTH PROPERTY LINE <br /> DEPTH <br /> DISTANCE TO NEAREST: WELLIJ <br /> I HEREBY CERTIFY THAT]HAVE PREPARED THIS APPLICATION AND THE K WILL BE DONE IN ACCORDAN PROPERTY LINE <br /> DRpIANC$S, ATE LAWS <br /> I RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: <br /> CE WITH SAN JOAQUIN COUNTY <br /> TITLEf <br /> I <br /> r <br /> xf C <br /> F { If <br /> I d <br /> F 7 ,— <br />