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v � <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN*NTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HE7oV44 DIVISION .y <br /> 304 E.WEBER AVE.,3P0 FLOOR.STOCKTON.CA 95202 (209)46b-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED +� <br /> JOB ADDRESS <br /> CITY2IP �J PARCEL SIZF/APNf _ B AA-- f_ <br /> OWNER NAME (�-�/F j//& JIM �b ADDRESS /" v2 <br /> CITYlLIP PHONE _� 2� p O <br /> CONTRACTOR �h�an/�L ADDRESS �I <br /> -r <br /> CITY2IP O `\G DAC z PHONE 83g <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X_ Y_TOWNSHIP_RANGE_SECnON <br /> PERC TEST(S) ( ) HOW MANY APPLICATION k: <br /> TYPE OF SEPTIC WORK: /✓ NEW INSTALLATION REPAIRIADDITION DESTRUCTION <br /> INSTALLATION WILL SERVE: 10ESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:-/ NUMBER OF BEDROOMS: f NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> O SEPTIC TANK/GREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PEG TREATMENT PLANT DISTANCE TO NEARESTpp: WELL FOUNDATION_S6L-/ PROPERTY LINE-- <br /> 0 LIFT <br /> INE _❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES INFILTRATOR CHAMBERS <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 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH ZIP LFfI�'YH-2-_ DEPTH �. Qz��sI <br /> DISTANCE TO NEAREST: WELL �,�_FOUNDATION <br /> S PROPERTY LINE <br /> ❑SUMPS 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 /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE:_ DATE:- <br /> 1 <br /> ATE: <br /> V I, <br /> 77 <br /> 1 11 77 <br /> h <br /> Z <br /> 0 <br /> Z <br /> V <br /> SA IG HE. TN " 'nP; 7DIv <br />