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LIQUID WASTE PERMIT ) <br /> ` �.." `''p <br /> 1 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTALPALTH DIVSSION <br /> F r <br /> 30d I?WEBER AVE.,3R°FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> 1i <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM,DATE ISSUED 24 HR r-j C>Tj C <br />'I JOB AoaREss—t37 I I�[Y (n FSE Qi 3- T� <br /> CTTYfZ]P - } r � � PARCELSIZFJAPN <br /> OWNER NAMEI.+'n._ 1`i(s .1 - ADDRESS I-_;� ) ! .-t 'r Z,'� T� '�h k"- -5 '6'l E' <br /> r•. <br /> CITYfLIP L.L. �1 i i PHONE <br /> - CONTRACTOR . _! ADDRS'S_ }}L <br /> ?U f,, <br /> CLTYfL1P ' <br /> 7 Wr 1 <br /> GEOGRAPHICAL INFORMATION:COORMANFES: X Y TOWNSHIP RANGE_SECIION <br /> i PERC TEST(S)( )HOW MANY - " APPLICATION#: <br /> TYPEOFSEPTIC WORK: ❑ NEW INSTALLATION__, d REPAIRIADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIOSNCE ❑COMMERICIAL ❑OTHER <br /> 1 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES <br /> ' CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITlSUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> 13 SEPTIC TANKl REASETRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS <br /> Q PEG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLINE <br /> ❑LIFT STATION SIZE - TYPE OF PUMP SAND OIL SEPARATOR iENC601SEO SYSTEM) <br /> Q LEACHING LINE NUMBER&LENGTH OF LINES I INFILTRATORCHAMBERS <br /> DISTANCE TO NEAREST. WEl-L FOL'.IDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> FT <br /> r. - DISTANCE TO NEAREST:WELL FOUNDATION: PROPER-q LINE❑MOUNDED WIDTH LENGTH DEPTH - <br /> S - DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE C� T <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH PAYMENT <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE RECEIVED <br /> Q SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE AUG 2 12001 <br /> F1]DISPOSAL PONDS WIDTH LENGTH DEPTH - , <br /> SAN JOAOUIN COUNTY <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE PUBLIC HEALTH SERVICES <br /> i.. �E#TAL HEALTH OMSIO <br /> f' 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES{S A'C"WS,'AND <br /> �{RULES AND REGULlTIO.YS'OF SAN JOAQUIN COUNTY. _ �r <br /> FSIGNED: r-7.r !��s] `� TRTE.I T'I ! " f <br /> oAlr <br /> 1 <br /> Ull <br /> J I I I <br /> CIT . <br /> ! 2 4-" o ] i `— I.. ir <br /> 4:• ) t l f C <br /> 1?; 1 ;s_., a F i <br /> p, t t G <br /> I I I 1 171 <br /> 5 <br /> I <br /> 3 <br /> APPLICATION AFOR DEPAITMFNT USE ONLY <br /> CCEPIFl)BY: -11 <br /> DA7P;,,w, <br /> . �..., <br /> '- TANK.PIT.OR SUMP INSPECTED BY: z DAT_ <br /> k' FINAL INSPECTION BY: <br /> COMMENTS- <br /> PE COU(; SC AMOUNT• CHECKJ�'r RECENED BY DATE PE:RMRlSERVICE REQUEST i SEPI[C LDA <br /> INFO R'EMrrtt 7 CAS <br /> ' T r <br /> z � " <br /> NNN . <br /> r � <br />