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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> # 304 E.WEBER AVE,.3w FLOOR.STOCKTON,CA 95202 (209)468-3sw <br />!, NON•Rfi NDABLE PERMIT EXPIR YEAR OM ATE f SUED 24 HR N(D'TI C E <br /> JOB ADDRESS l •1I Ij`�fU REQUESTED <br /> CTTYlZIP ccqC r PARCEL SIZFIAPN fw, 6 <br /> OWNER NAMEf"y(�jf�� j� ADDRESS , �- — i •� <br /> CTTYrlIP ILIAL PHONE / <br /> a CONTRACTOR { 0. <br /> f� ADDRESS f6 `� C'r4 `Yl <br /> _ CITYIZ]P_ C% S�_Sr <br /> PHONE r <br /> OEOGl!RA`PHICALINFORMAT(ION-`COORDIANTES: X Y TOWNSHIP_RANGE___5ECTION <br /> ��_yyyy•�' 4c5i�pnPaa� 4str)t �1 } �,)HOW �Y � F APPLICATION M. <br /> TYPE OF SEPTIC WORK: 0 NEW INSTALLATION C REPAIRJADDITTON 0 DESTRUCTION <br /> • INSTALLATION WILL SERVE: 0 RESIDENCE 0 COMMERICIAL E3 OTHER - <br /> 1 <br /> NUMBER OF,LIVING UNITS: NUMBER OF BEDROOMS'_ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMPSOIL CHARACTER: WA� �y <br /> � <br /> O SEPTIC TANKICREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTNINi r='V EC <br /> Cl PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PRO&RTYLINE ��1IUUffAO� <br /> 0 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> AUG 13 LEACHING LINT NUMBER d LENGTH OF LINESSANJOAOUIN COUNT} <br /> INFILTRATOR CHAMBERS -------ftBdC HEALN SEMICES <br /> DISTANCE TO NEAREST: WELLFOUNDATION PROPERTY L_4NMENTAL HEALTH f1MSlf> <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST:WELL FOUNDATION: PROPERTY LINE <br /> i 0 MOUNDED WIDTH LENCTH DEPTH <br /> � F <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> CJ SEEPAGE PIIS WITH LENGI'fi DEPIH 1 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 0 SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL _,_____,FOUNDATION PROPERTY LINE <br /> l.' ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> II4EREBY RTIFYT14A iHAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> -Olt TE LAWS,AND RULES AND RE ULATIONS OF SAN JOAQUIN COUNTY. ` <br /> DATE: 134 t <br /> SIGNE J <br /> ! i <br /> F�_ <br /> 11 � <br /> Imo. <br /> FORD PARTAI ONLY � <br /> APPLICATION ACCEPTED BY'. F DATE ��. <br /> 'TANK,PR,OR SUMP INSPECTED BY: DATE: , <br /> FINAL INSPECTION BY: <br /> PE CODE 5C AMOUNT CHECK REC IVEDBY DATE PFRMITISERVICE REQUEST SEnlcuw <br /> INF ReVITTEO <br /> i <br /> Fl <br />