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LIQUID WASTE PERMIT <br /> SAN IOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E,WEBER AVE.;3PO FLOOR,STGCKTON,CA 95202 (209)468-3420 ,�f�- FIR <br /> R <br /> ' N- F PERMIT EXPIRES I YEAR FROM DATE ISSUE c <br /> 1 JOB ADDRESS O V I.,�4-y� L}.r� [ ,rl/s lC erd - L 0(,h-(-, <br /> M CITY2[PCS I /��[lLl�l lA� 1 �f 1 l'. PARCELSIZFIAPN <br /> �,. OWNER NAME5'i � }t1C�lC 1�� yF\ �4'I.ADORESS �f oo ♦rfl/1}T If(',(i L! 0 <br /> S CITYPLIP_ �rFFl �.+�S//CL } �6( } PHONE y,,,, ` �-( (.. <br /> CONTRACTOR__J`�'( I I S��• 3'�Y'(�-l'Ie:L 4'7 5)UL. ADDRESS ZZ oy �'9•l i-N L-c'^ <br /> CITYrzIP L r'1� rR� Cf t!(� PHONE � 7�f 7- `570 1 - L'�524D <br /> GEOGRAPHICAL INFORMATION:COORDIIANTES: X Y TOWNSHIP_RANGE_SECTION <br /> PERCTEST(S)4/f HOW MANY �G.?'1 APPLICATIONpI <br /> TYPE OF SEPTIC WORK: ❑ NEWINSTALLATION ❑ REPAIRIADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER' <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OP EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: P1TlSUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> 11 SEPTIC TANIi1GREASE TRAP TYPElMFG CAPACITY NUMBER OF COMPARTMENTS <br /> i� . <br /> ❑PKC TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION - PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) Lv,t'. <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES i INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> O FILTER BED WIDTH LENGTH DEPTH - <br /> ',N <br /> DISTANCE TO NEAREST:WELL FOVNDAT[ON', PROPERTY L[NE <br /> [3 MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH - <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE ' <br /> {�e <br /> ❑Sumps WIDTH LENGTH DEPTH - <br /> DISTANCE TO NEAREST: WELL. FOUND TION PROPERTY LIN , <br /> I+ C3 DISPOSAL PONDS WIDTH LENGTH DEPTH '" S <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE I <br /> I't - I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE'WORK WILL BE DONE IN ACCORDANCE V�ITH SAN JOAQUIN COUNTY - <br /> -' ORDIANC ST/yrll'E A{WS.,AND RULES AND REGULAT70NS OF SAN,JOAQUIN COUNTY. <br /> 's4I <br /> ::r �FC. <br /> ;.SIGNED: � .. 4V�.."'i- 1'' 0.0.�'�1ACQ4yyN f'..�����C I, � ��:� 7`ITLE: FC. +...I .DATE: <br /> FF <br /> 4A AL ITO, <br /> /1:1 ..• <br /> _ PA$Cffi. `�p7F 'SF <br /> 1 - 2x 7.ACRES S 2�7 AfTRErS P'i4- 0�'H at "aa h�(�lI >c5� <br /> � ' I :1 1°'r.#'3c' a IVllU 'si 2 <br /> PAjiC AC IB J E kJl <br /> 18fi� ', 7� : 17 � A441E5 Sr. N,)Q-24 <br /> )Q <br /> :PARC R26 ?i77� is id's` 3g 176r Lasa" °i" 26s 90' LIC'{ NEALT <br /> AR ACRES VIROt f.N Ai <br /> 74: N <br /> 14 <br /> {J - u1 m� w PARCEL 20 PARCEL 10 I <br /> .i�j < U4, a 215 ACRES 2.06 ACRES' IIS�f' A.- 1 <br /> PARCEL 27166, 26E, <br /> 1 a <br /> 17§' 176• Y <br /> pet(, <br /> PROPERTY LINT <br /> 7 d See. Ole, � <br /> ---- 1/4 SECTION l <br /> l 1 1 m(o <br /> OPPEXISTING POWE' � O EmSPNO SOIL <br /> - <br /> - FAI <br /> ..__- .__:'..-_. .., _.-, .._OA N MBEF <br /> MOORLAND q <br /> BLOCK <br /> B0' EDWARDS - ROAD _ <br /> .,-ntRN7 US1's. NLY., - <br /> � '= .APPIJCATION ACCE BY: ��. �W�'"IOC.s GATE: <br /> FANK,PIT,OR SUMP INSPECTED BY, _AATE, G-VA <br /> :'.Y'-•1 FZNALINSPECTIONBY: <br /> COMMENTS: <br /> I - <br /> E PECODE SC AMOUNT CHECK# I RECBIVEO BY DATE PERMITlSERVICE REQUEST R SEPTIC IDI, ' <br /> .3 INFO RCMrTTFD M. <br /> a. . <br /> i y- ,i - - - <br />