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*..,,LIQUID WASTE PERMIT <br /> l7 4 `IS" e' SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEAH DIVISION <br /> 0 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 (209)468-3420 n , <br /> \ NON-REFUNDABLE.PERMIT E PIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS✓/// , — <br /> CITY/ZIP Z 0 f / PARCEL SIZE/APN/fE4? X�11111_c <br /> OWNER NAME^C /Al J/�L/h �(�l/ ADDRESS <br /> CITY/ZIP / PHONE <br /> CONTRACTORgQII U� `S ////���.r ��. ADDRESS�'121e=Z 4 <br /> >ymmP Int, � PHONE `` PAYMENT <br /> RECEIVED <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIPRANGE_SECTION (� <br /> PERC TEST(S) ( ) HOW MANY APPLICATION#: AUG 2 9 2000 <br /> FSEPTIC WORK: ❑ NEW INSTALLATION ) REPAIR/ADDITION ❑ DESTRUCTION <br /> COUNTi <br /> CATION WILL SERVE: ❑RESIDENCE MMERICIAL ❑OTHER SAN it t _,N SERA M <br /> R OF LIVING UNITS: NUMBER OF BEDROOM NUMBER OF EMPLOYEES: ENVIRONPIIENTAL HEALTH(IV JI+ <br /> CTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> IC TANK/GREASE TRAP TYPE/MFG ��V� CAPACITY NUMBER OF COMPARTMENTS�y� <br /> TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 4EACHING 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 LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION 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 CERT HAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES LAWS,AND "AND EGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE: -DATE: <br /> DATE: <br /> r � <br /> AUG 0 AN <br /> rim flr)4j;w&ir.4 <br /> plop <br /> F�ORD,EP_AR_JT{M T UIONI <br /> APPLICATION ACCEPTED BY: , `� �'/�,`r'tM'� DATSIM0CJ 1:2 � <br /> r A <br /> TANK,PIT,OR SUMP INSPECTED BY: DATE: U <br /> FINAL INSPECTION <br /> COMMENTS: <br /> PE CODE SC AMOUNT CHECK#V RECEIVED BY DATE PERMIT/SERVICE REQUEST# SEPTIC ID# <br /> INFO REMITTED <br />