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LIQUID WASTE PERMIT <br /> SAN JOAOUINCOUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL Hb, ,,DIVISION <br /> 304 E.WEBER AVE Y6 FLOOR,STOCKTON,CA 95202(209)4611-3420 <br /> .I, <br /> I.q <br /> ' Na r OF- EF NDAg(;�P: NIT F.XPI]tF-N 1 YEAR FROM DA-M,WIUUE <br /> ]OB ADDRESS tfh •� P[ .-. APNV. y PARCELS[Z8�—� <br /> QTY Lr BUILDINGPERMFTR O g - .. <br /> � fi •..--- r. <br /> }`-- OWNER NAMP. 4/�• m %_ !%7�� .724:1,( i_rr ADbRESS <br /> f + CMVIMF PHONE NUMBER <br /> I CONTRACTO Yr+ ADDRESS� 5J/ <br /> cTrvlEEP PHONE NUMBER_ IDD <br /> ! 7 GEOGRAPHICAL INFORMATION:COORDINATES:X__ Y TOWNSHIP RANGE SECTION <br /> F-� <br /> );MOF SEPTIC WORK; IN ALLATION WILL,SFRV6: NUM$EROF LIVING VNITS:,k <br /> EW INSTALLATION ESIDENCE NUMBER OF BEDROOMS: <br /> O REPAIJUADDIT10N ((( O COMMERCIAL NUM61 ROP EMPLOYEES: <br /> ' Q DESTRUCTION O OTHER <br /> O ENGINEEREDIALTERNATIVE ' <br /> CHARACTER OF SOIL TO OEMOF31 PITISUMPSOIL CHARACTER; 1 -WATERTABLEDEPTH: <br /> d <br /> 1,ERCTE9r(5) HOW MANY APPLICATION � <br /> SEPTIC TANK TYPEIMFO CAPACITY L 60 6 0-OF COMPARTMENTS r <br /> © 144 <br /> GREASE TRAP TYPEIMFG� CAPACITY NOFCOMPARTMENTS �3 <br /> 1 <br /> O warx PLANT DISTANCE TONEAREST: WELL. FOUNDATION- PROPERTYIlNE_L�-- <br /> C <br /> O LIPTLTAT1oN SIZE rYPEOFFUNr SAND OIL SEPARATOR(ENCLOSED SYSTEM) I�1 <br /> ��n y ( f <br /> LEALINE NOF PS: !� LENGTH OF LING:. CJ p�,�FTONWRLST: SVELL�I FOUNDATION-!b r AROPfiitTY 1111E l6d 't <br /> LIT A RCHAMBER& -� <br /> Q FILTER BED WIDTH LENGTH DEPTH DI6T4NCET0NEARIST: WELL FOUNDATION PROPERTY UNE <br /> 1 <br /> O MOUNDED WIDTH LENGTH DEPTH PWANC&TO NFARIAT: WELL FOUNDATION PROPERTY UNE <br /> jA SUMPS WIDTH LENGTH DEPTH DImANcFTommiamn WELL FOUNDATION PROPERTY LINE <br /> . ❑ DISPOSAL PONDS WIDTH LE140TEL. DEPTH DISTANCE TO NRARESTI WELL FOUNDATION PROPERTY UNE <br /> s� / I r <br /> ( SEEPAGE PTTs Y - DIAMEIER� DEPTH DiSTANEE TO NEARERTi WELI.I aa* FOUNDATION PROPERTY LINE rC,0 ¢ J <br /> 1 BEREBY CRRTIFY THAT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BA DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS <br /> AN LES AND REGULATIONS OP BAN JOAQUIN COUNTY. <br /> I -MU DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL j209146"27 <br /> SIGNED: TITLE: DATE: <br /> i <br /> he <br /> _���.I - - _- _ � it '• __T-�I <br /> {{{ II <br /> - - - -4 T.._t <br /> IS <br /> -t-- - ' --—1--- -T-- t I <br /> it F <br /> ET - - - �- <br /> '^I I I IQ fN 1 F N n 91 H <br /> DEPARTMENT USE ONLY r� <br /> -APPLICATION ACLTiPTP.DBY: 4 �` DATE: AREA_"EMPLDYEEtog__%�7 I LOCATION, 1 <br /> PERMITHNAJX YESDATE.­ -I E <br /> k COMMENTS:_ nJ <br /> • PE tDDE EC FD AMOUNT CHECKWCASH RECEI YED DATE PER INYOEm gEP[R:iDF <br /> 1 REMITTED RY /Iy� <br /> 32-0 <br /> 9"0- <br /> I <br />