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v <br /> LIQUID WASTE Pbo&lIT <br /> TA SAN JOAQUINCOINIY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 306 E WEBER AVE.3'-FLOOR.STOCRTON.CA 95202 (209)468-MM <br /> exn 9 I VEARMOM DAT <br /> Y� LOB ADDRESS > y„ ,;1'/ /F-f'-':'•`f•:2 If�� <br /> CIWMP I "•„y f-. PARLfi SOEIAPN ,•�'`- f F��.•.{�•'�:r�.Al <br /> OWNFA NAME '1 -{'-: ADDR65 <br /> _ <br /> CM ZPw PNoNe -f - ��•;4 <br /> CONTRACTOR I�IJ 1:16y F'C�L� ADDRESS O A! <br /> GEOGRAPHICAL INTVRMATgN:COORDIANIFR: x_Y_TOWNSH@_RAN(JE,—SBC=N_ <br /> PERCTESTIS)(XHOWMANY /'.` APPLICATIONR: <br /> TYPEOFSEPUC WORK O NEW INSTALLATION 0 RFPAIR/ADDIIION 0 DESIRURION <br /> INSTALLATONWILLSERVE 13 RESIDENCE OCOMMERICIAL DOTHER <br /> NUMBFAOFUVINGUNITS:_ NUMBER OFBEDROOMS:_ NUMBEROFEMPLOTEES:_ <br /> CHARACTFRQFSOILTOADFPITIOF3FI=: MnUMPSOILCHARACT : WATER TABLE DEYIH_ <br /> O SEPTIC TANKGREASE TRAP TYP M CAPACITY NUMBER OF COMPARTMFfHS <br /> O PRG TREATMENT PLANT DISTANCEMNEARFST: W'FJ.L_ FOUNDATION_ PROPERTY UNE- <br /> 0 U <br /> ONE0UI STATION SITE TYPE OF PUMP SAND OIL SEPARATOR(ENCOSED SYSIE]O <br /> O LEACHING LINE NUMBER&LENGTH OF t1NES— INFILTRATOR C BORS <br /> DISTANCETO NEAREST: W0l. FOUNDATION PR0P0l'TY LDR <br /> B. omE BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST.WELL FOUNDATION: FRQPPM LINE <br /> O MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY TRIG <br /> 0SEEPAGE PT TS WIDTH LFNCIH DEPTH <br /> DLSTANLETO NEAREST. WELL FUUNDATON pROPIXTYtJM <br /> O SUMPS WIDTH IENGIN DEPTH <br /> DTSTANCETONEAREST: WELL FOUNDATION PROMWLINB <br /> i ODLSFOSALPONDS WIDTH LBTIGTH DEPTH <br /> DLSI'ANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I IRBOY C)18' TIIAT I HAVE PRBPARED"IS APPLICATION AND THE WORK WILL BE DONE W ACCORDANCE W FIR SAN JOAQUIN d1UYTY . <br /> :' OIDSANCPR,BTATR(AVIS AND RALE/qSANDilECI11:AlTONSOF8A8�J04QU1N '/� <br /> _ SM.NFb 1102 A (�.- _ TR1E{�I�O�I:'•\ICI DAil.11... 6-0 <br /> 4. J DCorncao-M Aormw.n_/�—wcoA. <br /> NIC ioLS ROAD arm n.rL i <br /> /3� ,yaar• —w/ec. se BTAe+s• ` <br /> .Yk <br /> '•s <br /> CIV i]~ <br /> PL 6 PGLK 5 I J]GaiLK 9 7jnv���11, <br /> _rmiys.n]LqarvciA. <br /> . <br /> � <br /> c <br /> k �ARGEL I i <br /> �� 110 <br /> o AC, <br /> APH.005-08P•25 A^ 005-o41A1] B,i Jg J, 4--4 23 ARL ilot 3 <br /> !� vS � ;tPAY <br /> RECEIVEn c <br /> y_ GOUNI <br /> 151 Wxl x� k,peLICNEwHSEVaEs _A... <br /> Ta HfrSlI <br /> � POIOVARTLRMT IEE OHLT <br /> APM11CATpN ACISI®BY����ZZ_ OAR / J..IZ <br /> TANK nT.00.5U14M5P�IHIBY�R <br /> F9LLLM5MGroM0Y <br /> r <br /> tD14101IS: <br /> PECDDB SC AMIXIM CIffiCKu� R�®VD)BY DAIB P0IMIEBRVP'SREGVER• SPPIICBM <br /> Bi R <br />