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flNvommENTµHEALTH LIQUID WASTE PERMIT <br /> s UIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTII DQSI* H R 'N QT!C_-E <br /> SPECIAL. PEK i t'-L WEBER AVE.•3'0 FLOOR.STOCKTON.CA 95202 (209)46R-3420 R E'C?L!IE'ST,c E) <br /> NON-REFUNDABLF PERMIT EXPIRES 1 YEAR FROM DATE ISSUED F(D R ALL <br /> JOB ADDRFSS_Aj=LI k L /ni l IGK- �7 /l N <br /> CITY/LIP lOcL PARCEI-S17FS <br /> JAPN © 1 !7C) <br /> OWNER NAME. JC�sI� �� �LIGA�i�._.— ADDRESS_3�rsrr I <br /> CITYIZIP_ <br /> PHONE___ <br /> CONTRACTOR�c �L._1GLlCs �»� ADDRESS—9-/R Z4.j- 7,16� mo <br /> C3TY/LIP &erf--� �7d' PHONE <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP_RANGE_SECI'ION_—BECEIVED <br /> PERC TEST(S)( )HOW MANY APPLICATION•: --OCT 6 2000 <br /> TYPE OF SEPTIC WORK: $ NEW INSTALLATION ❑ REPAIWADDITION ❑ DESTRUCTION <br /> INSTALIATION WILL SERV& ❑RESIDENCE SCOMMERICIAL ❑OTHER_ IN COUNTY <br /> NUMBER OF LIVING UNITS: NUMBER OF BF.IINOOMS•_ NUMB F,9 OM H:MI'IAYF.FS: U LTH SERVICES <br /> ENVIHONMEWAL HEALT14 ORASI <br /> CIIARACTER OF SOIL TO A DEPTH OF 3 FEET: fk00Jd�tIT dam PITISUMP SOIL CHARACTER: L WATER TABLE DEPTH Li <br /> Cl SEPTIC TANK/GREASE TRAP TYPCIMFG N4rA.L _ CAPACITY-AW >r" NUMBERCFCOMPARTMENT'S._pt <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL �*J FOUNDATION fR� PROPERTY LINE_ <br /> ❑LUTSTATION SIZE TYPEOFPUMP SAND OIL.SEPARATOR(F.NCIMEDSYSTEM) <br /> dd <br /> 11&LEACHING LINE NUMBER&LENGTH OP LINES 7L Z_Q� INFILTRATOR CHAMBERS y/� <br /> INSTNU <br /> ANCE TO NEAREST: WELL 1f0, FOUNDATION PROPERTY NE �31�1(/r_ <br /> ❑FILTER AFD WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST:WELL FOUNDATION:_ PROPERTY LINE .Vjl <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL 17OUNDATION PROPERTYLINF'. <br /> ❑SEEPAGE PFTs WIDTH LENGTH ,DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> SUMPS WIDTH 14, LENGTH Jel—DEPTH <br /> DISTANCE TO NEARF_S"I': WELL FOUNDATION J001 PROPER'T'Y LINE j <br /> ❑61sP05AL PONDS WIDTH_ LC.NOTH DEPTH <br /> DISTANCE TY)NEAREST* WELL _FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY TIIAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,S TE LA WS,AND RULES 'D REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE: 0egu GkAe, DA-rt:"a g4w <br /> � I i <br /> INN <br /> tax I <br /> !— <br /> I I � <br /> 1 tru <br /> I � <br /> 1 <br /> FORDEPARTMENT ISE ONLY n <br /> APPLICATION ACCEPTED BY'_. DATE: <br /> TANKPIT,ORSUMPINSPECTEDBY.__ . <br /> HNAI.INSPECRO — 7 <br /> COM-MENM t <br /> �0 �u zo '7001 .t �i L� r e� <br /> IWI i <br /> PECODE SCOU t'. �/ .-E ED BY DATE PERMITISERVICE SF.PTK IDM <br /> '^I' _ INFO :MfI7ED LA511 <br />