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LIQUID WASTE PERMIT <br /> �^ SAN JOAQUIN COI INTY HCI IEALTII SI?RVI('I.S FNVIRONMIINTAL-. �, 1:I'll DIVISIO <br /> 304 E.WEBER AVE.,IND FLOOR.SI'(('KT0N,CA ')52(12 (209)468-3420 1 <br /> NON.REF INDAitt.ls I'1?I21 JIT EXPIRES I IY�E{Alt FROM DATE ISSUED <br /> 09 , <br /> 1013 ADDRESS_�/(,�/ <br /> CITY/ZIP�1 1'0 <br /> l(�,////`7777����n1111 \^ �y�,� PARCEL SIZE/APN c) b,-y- 4� <br /> OWNER NAME C,. l�K�n V l �/u/Y C\ADDRESS_! , 1 L0�/^�/,�-/ <br /> CONTRACTOR <br /> CITY/ZIP F (2ck C3 / C) PHONE 62 lV <br /> �)Q i D. ,�Yl'�•Q/lS00 ¢�c S�C ADDRESS 2 p N H13-Lk � L <br /> / kJ 2 <br /> CITYIZIP� ►v w-I� PHONE -7_v� d 1 0 <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP RAANGE_SECTION <br /> PERC TEST(S) Vo`HOW MANY 6 APPLICATION N: L-A - O 1 - 1 Z <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:— <br /> CHARACTER <br /> MPLOYEES:CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS J <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 13LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS 'I <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH C- <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 LENGTH DEPTH - <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE J <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 CERT THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> 0RID'DANCE AT'LA AND U ES ANU RE ULATION.'OF SAN J A UI COUNTY. <br /> SIGNED: oft TITLE: DATE: 69-6-03 <br /> SIC]0-•-I —SEC 71 <br /> SEC318( I NEC)7 <br /> irs a ) O"N <br /> ((�4� "f OIL <br /> 70— - 20• �Y.' 301-1100-11 <br /> c41 <br /> �N 00.OT 10'E <br /> 9 {T <br /> -b,J I <br /> a sb I P <br /> 'd n <br /> INPDIE �Er - -------- -� R - �i <br /> r- <br /> 1�1 <br /> s 0e'5645w!--'m%' e9 9 1 +c PARCEL`— -- -- I R J U t on <br /> i <br /> zPARCEL"T' ___ —._.FaISTM PROP RtV EINES <br /> Q I IY)Qy 70 S M. 150.00' ^� CW WICERID REi111 i'1 it <br /> 7L —HER NUU5710 <br /> Oe'Se'45'E 500.01' rRUPI NfI IINfS 1 DEEti1D - ` <br /> PARCCe Iw.w q i i 2 <br /> Pam—, -Aa J cT' I• $ <br /> 1� s erse'I5 t 500.00' ENVIROW AL I DVI N <br /> T I PARCEL.• , <br /> . ... .. z' - - <br /> 15400 1 COONCE <br /> �} I I-" \Oe•5fi•]'1. 500.90' 8 I ; 703-MO-10 <br /> EC�j 5� PARCEL"2" Iso.00 k K <br /> O II IG� ao..E ,a <br /> x ee•se'o•E seo.9lr <br /> PAR <br /> CEL"I" t <br /> — <br /> II� seuw <br /> 2o0w <br /> -I 7 S.S.J.IJ)JRICHT-OF-WAY <br /> � �r.5.'•-' :0.00' <br /> : �JL/(�/(�E� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> DATE: <br /> TANK,PIT,OR SUMP INSPECTE BY: DATE- <br /> FINAL INSPECTION BY: . 1-310 5 <br /> COMMENTS: Lk? a • -H-AA,- U <br /> 'h <br /> PECODE SC AMOUNT CIIECK M/ RECEIVED BY DATE PERMIT/SERVICE REQUEST N SEPTIC IDN <br /> INFO RI-.11F. <br /> zzZ 51 4s lz9 /�!c S 00 3+ l 4 Q <br />