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3: <br /> LIQUID WASTE PERMI <br /> ,, Z ZO-4, 36- w. G©V <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL-f1EALTH DIVISION r, <br /> WEBER AV 1RiERMIT <br /> FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> �. N N BL EXPIRES 1 YEAR FROM DATE ISSUE <br /> JOB ADDRESS <br /> CITY/ZIP � PARCEL 51ZE7APN <br /> qI- zqo - .2 <br /> 3ZZ, S <br /> ED <br /> 1lAT �l ADDRESS <br /> `ten <br /> OWNER NAME q r� `� <br /> VIATC_Cp.. 1 r PHONE <br /> CITYfLIP /%/1llirllll <br /> CONTRACTOR iii/ � +^1 �� �� ADDRESS . <br /> I 9�JPHONE . <br /> 4 <br /> CITYfLIP <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP--RANGE----SECTION <br /> PERC TEST(S) `c HOW MANY _ APPLICATION#: <br /> TYPE OF SEPTIC WORK: X NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ACOMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ' CHARACTER OF SOIL TO A DEPTH OF 3 FEET: �l PIT/SUMP SOIL CHARACTER: <br /> WATER TABLE DEPTH <br /> 4 ❑SEPTIC TANKIGREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> I ❑PKG TREATMENT PLANT. DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE - <br /> p ❑LIFT STATION SIZE ' TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES_ ! INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 3 <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> i. <br /> i DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> i DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE- <br /> El SEEPAGE <br /> INEElSEEPAGE PITS WIDTH` LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> f ❑SUMPS WIDTH LENGTH DEPTH <br /> M , DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ii <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> 1 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THATi HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STA Al D ONS OF`SAN JOAQUIN COUNTY. 'll� "� Q� <br /> SIGNED: <br /> TITLE: " `�+ DATE: <br /> 1 Be AC I I.ti Io!• <br /> r[ IICC 1051[ I t021C 101 FC 101C zt ,+ .• , <br /> l Q {,Q; Q Q © Q i a a l aeau 0 <br /> rr <br /> KLO - ' - LROADfa <br /> isa i� s s, r° Y7 'T �Y��r <br /> rrne -, <br /> C� <br /> L7 <br /> �� za <br /> �y 2 <br /> .' POR. SW. I/4 SSC. 14 <br /> SCALE I Y 200' <br /> C\ '= 10 <br /> SAN JOAQUIN COUNTY �-�' ��lry1 n <br /> ASSESSORS MAPS C <br /> u <br /> FOR DEF' TMENT USE ONLY <br /> - APPLICATION ACCEPTED BY: - e _G` - — _ _ -- `I _ =DATE: <br /> TANK,PIT,OR SUMP INSP <br /> 1�Qcl�t�il� <br /> FINAL[NSPE [(hi'BY; - - � ` F j-----., <br /> COMMENC! Y � - oiN::^:'~,3-�S"�'� / :cs y � <br /> PE CODE SC AMOUNT HECK It/ RECEIVED_BY DATE PERMITISERVICEREQUEST# SEPTIC'" - C <br /> INFO RFMPI'I'ED , G S <br /> M ofi- 113473, 2oafg <br /> :�1� <br />