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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL IIIiAI:TH DIVISION <br /> 304 E.WEBER AVE,3"FLOOR.S'1'OCKTON.CA 95202 (20))465-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS r27r-)-7P�N <br /> CITY2IP_ I K iY PARCEL SIZEAPN 20 y It.o:. -of- <br /> OWNER NAMERr"I'll_ c ADDRESS P.C. hCVV �3a <br /> "- <br /> G <br /> CITY2IP - ` '^ n`�/+/� ,1/^- PHONE <br /> CONTRACTjOR-�Ne11M. /��/�I/��'MI 1 fltY of �� ADDRESS J4�1�1`1-�1�-1 <br /> CITYIZIP 1.._l 95240 240 PHONE�2 88 -� 1 -� 101 A�LLJJ <br /> GEOGRAPHICAL INFORMATION: COOR��DJJIANTES: X Y TOWNSHIP� ?^C <br /> RRANGE SECTION� <br /> PERC TESTIS) (X HOW MANY OC APPLICATION N: M Oct " O/ <br /> TYPEOFSEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 13 RESIDENCE ❑COMMERICIAL 13 OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MFG CAPACITY NUMBF.ROFCOMPARTMENTS <br /> ❑PKG'IRT-.ATMENT PLANT DISTANCE'I'O NEARNST: WELL POUNDA'ITON PROPERTY LINE <br /> ❑LIFFSTATTON SIZE TYPEOFPL)MP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS Q <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH C <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 11 SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION CRO <br /> ❑SUNIPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY C Y TIIA EPA D THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANC ATE LA S, ND RU S NUIR�GUNATIONS OF SAN JOAQUIN COUNTY. /' <br /> SIGNED: TITLE e J e'i / <br /> DATE: <br /> 650.75' <br /> Bi <br /> Lo <br /> m io <br /> B;to <br /> -ETT7 IQ <br /> a, <br /> N O <br /> m <br /> N 5 <br /> El %n N E T, <br /> 661.fl0' FA rH 3E AH M NT <br /> FOR DEPARTMENT USE I(NIA <br /> APPLICATION ACCEPTED BY/ DATE: <br /> TANK.PIT, SPE Y: <br /> FINAL IN ION COMMENTS: <br /> PECODE SC AMOUNT RECEIVED BY DATE P MrtISERVICE REQUEST N SEPTIC IDN <br /> INFO I REMITTED ASH <br /> a i8 u SOD 3 <br />