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LIQUID WASTE PERMIT 24 "P. r 30-''i E <br /> SAN JOAQUIN COUNTY PUBLIC HEALTHSERVICES ENVIRONMENTALHEALTHDIVISION Ft UESTE <br /> L 309E WEBER AVE,3"B FLOOR.STOCKTON.CA 952M (209)668-3020 p LL <br /> .,,//��Q R 1 N- P PI RFR M INa SPEC-FRDN <br /> L JOB ADDRESS L! IF L2L (+t�K q <br /> CITYZP �� a,, '1 5 3-z o ARCELSITFIAPN P� �I _I L, <br /> OWNER NAME �6ILM $ cy.Pcxpj q9p.. lk�ADOA( <br /> CITy2Lp CIJ 1 `lf y� HONE <br /> L CONTRACT OR � � n r•� \6 hS�GC-1 f 6 F� ADORBSS I�Q 1 � ��� �� <br /> =AUP MOM Talo a}t}3$'/S"F56 61 `rY'S"7Y•3 <br /> GEOGRAPHICALINFORMATION:COORDIANTES: X Y TOWNSIUP�UNGE_SECHON_ <br /> PERC TEST(S)( )HOW MANY APPLICATION*.. <br /> ` TYPEOFSEKDCWORK: ❑ NEW INSTALLATION .011UEPAWADDITION ❑ DES'IRUCDON <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMEWCIAL ❑OTHER PAYKALiN <br /> I NUMBER OF LIVING UNI'IS:� NUMBEjt OF BEDROOMS:-,TG' NUMBER OF EMPLOYEES: ---TTI ,_ <br /> L, CHARACTEt OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMPSOILCHARACTER: 'fIATEKT4BLEDEPIH.f--- <br /> 13SEPTICTANKJGR6ASETRAP TYPEIMPG CAPACITY NUMBEROFCOMPARTMEN'IS <br /> ❑PKGTREATMENTPLANT DISTANCETONEAREST: WELL- FOUNDATION- PROPPRTY ANJU�IUUIiSLlq RUNTY <br /> FNVIRn tlfNTAt HSERVICES <br /> L ❑LIFT STATION SRE WMOFPUMP SAND OILSEPARATOR(ENCLOSED SYSTEM) FNVIRUNMFNTAi MFAI?fIPVIS Lin <br /> r <br /> XLEACHING LINE NUMBER&LENGTH OFLINES /�' (Z INFILTRATORCHAMBERS <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERWLINE <br /> L ❑RUJSK BED WIDTH LENGTH TO DEPTHT^FF <br /> DISTANCENEAREST: WELL-2M FOUNDAVON: PROPERTY LINE <br /> IJ MOUNDED WIDTH LENGTH DEPTH <br /> L I/ DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> IlY -AGE PITS WIDTH� LENGTH DEPTH� / <br /> '^\ DISTANCETONEARREST: WELL - _ t FOUNDATION. PROPERTYIINE <br /> ❑SUMPS WIDTH LENGTH 0 DEPTH <br /> DISTANCETONEAKEST: WELL -- FOUNDATION PROP WLINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORR WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> L ORDIANCES,SI�$LAW�S AN D' ULFS Ap���EG LATIONSOFSANJOAQUINCOUNTY. <br /> SIGNED: C 111:'x. `I n n\ = TITLE: DATE: <br /> r <br /> TT I <br /> d <br /> io .X I <br /> m <br /> Lx � ✓ <br /> I U <br /> -41 <br /> I <br /> F D2PARTMFMUS&ONLY <br /> AP PLICATIONACCFTTEO BY: A <br /> TANK.PR.OR SUMP INSPECTED BY: DAIL <br /> FlNALINSPFL'1'ION BY: <br /> CORMAtFM$: <br /> v Q <br /> ME E SC AMOUNT CHBCKN REf91VMBY I <br /> DATE PBRM BRVICEREQIIEtiI'I SPPOC mO <br /> L <br /> 2-10 T CASH al o <br /> L <br />