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E <br />' F F <br /> k <br /> k <br /> i <br /> I <br /> E <br /> h <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"FLOOR,STOCKTON.CA 95202(209)46K.3420 <br /> _ NDN-REFUNDABLE PERMIT E%PiRE3 1 Y'F.AR FROM DATE <br /> ISSUED <br /> JOB ADDRESS V - • APN 6 3 /Q r PARCEL SIZE: <br /> CITYlZIP v�, BUIL �� �DING PEAMITY �3 ',.� ! <br /> OWNER NAM E�/ .dmf±,(9�7'! ✓1�" ADDRESS <br /> CITYIZIP PHONE NUMI3ER <br /> CONTRACTOR_ _�G�i j'1�1"'v f ADDRESS .� � � iQL�(Y-lt�,(� <br /> CLTYIZIP �,_.�, ky 1C/� PHONI,NUM RER i� CtJ 92— <br /> GEOGRAPHICAL INFORMATION:COORDINATES X Y TOWNSHIP RANGE SECTION <br /> TYP F SEPTIC WORK: INST ELATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> F NEW INSTALLATION 7SIDENCE NUMBER OF BEDROOMS: `7 <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> O DESTRUCTION ❑ OTHER ,} <br /> ❑ ENGINEERED/ALTERNATIVE. - -0 D,2-,3 Dq <br /> CHARACTER OF SOIL TO DEPTH OF 3% PITISUMP SOI L CHARACTER:' WATER TABLE DEPTH: <br /> ❑ PERCTEST(8) . HOW MANY APPLICATION# - <br /> ❑ SEPTIC TANK TYPE/MFG {.—�` CAPACITY ZUOO #OF COMPARTMENTS C <br /> ❑ CREASETRAP TYPE/MFG CAPACITY 9 OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE of PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> - ❑ LEACH LINE ON.PINES' LENGTH OF LINES' pICTANCE TO NEAREST: WELI��D - FOUNUATION)y PROPERTY LINE,;t( <br /> -INFLI7RATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH D—ANC TONEAR— WELL FOUNDATION PROPERTY LINE Q <br /> ❑ MOUNDED WIDTH LENGTH DEPTH OILRTAn TONEARM; WELL FOUNDATION PROPERTY LINE <br /> ❑ SDMPS WIDTH LENGTH DEPTH MMN[ETONEARL411: WELL FOUNDATION PROPERTY LINE <br /> 1 <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH PMANCETONEAREW; WELLryry FOUNDATION PROPERTY LINE <br /> ,, � J <br /> r ❑ SEEPAGE PITS # -. DIAMETER r DEPTH Dlsrwna TONEAREFT: WFLf�[✓ FOUNDATION�Q PROPERTY LINES""� <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> Ag <br /> MINIMUM 24, UR VANCE NOTICE REQUIRED FOR INSPECTIONS--PLEASE CALL'( 9)468-3423SIGNED: L� r TITLE: �i /( DATE: <br /> L��I <br /> 11J, <br /> I II _ II I I _i 1-)- I--� i <br /> - _ <br /> II ff I I1 , <br />