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" LIQUID WASTE P <br /> RMI. . <br /> SAN IOXQUIN COUNTY PUBLIC HEALTH SERVICES ENVIiONMENTALHEALTH DIj2Il,,,���,,, B <br /> t 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 {209)468-3420 <br /> r i ON-REFUNDABLE PERMIT EXPIRES'1 YEAR FROM DATE ISSUED <br /> JOB-ADDRESS �� <br /> CITY/ZIP <br /> OWNER NA ty x PARCEL SIZEIAPN <br /> 3 :' \ <br /> ADDRESS,.:�D. /C�,,..f- <br /> Irl 0 <br /> CITY/ZIP <br /> CONTRACTOR01 <br /> ';p <br /> P <br /> YILI <br /> PHONE:t.. <br /> GEOGRAPHICAL INFORMATION: COORD <br /> [ANTES: X :. <br /> -- Y TOWNSHIP_RANGE�SECTION <br /> S PERCTEST(S) ¢ ) HOW MANY <br /> APPL'ICATI <br /> TYPE OF,SEPTIC WORK: ON <br /> ,P <br /> ❑ .NEW INSTALLATION <br /> ❑ REPAIR/ALiDITION ESTRUCTIONI'� <br /> ' fSTALLATION WILL SERVE: ❑ NEW <br /> r' <br /> 1.. „I O,COMMERICIAL C] <br /> NUMBER OF LIVING UNITS: OTHER <br /> NUMBER OF BEDROOMS 1 NUMBER OF EMPLOYEES <br /> J CHARACTER OF SOIL TO A DEPTH 01`13 FEET: <br /> PITlSUMPrSOIL CHARACTERi <br /> ❑SEPTIC TANK/GREASE TRAP" '' WATER TABLE DEPTH' <br /> TYPElMFG <br /> CAPACITY NCIMBER OF COMPARTMENTS <br /> �� D PKG TREATMENT PLANT WELL <br /> W DISTANCE TO NEAR T <br /> ! " FOUNDATION'S :'PPOPERTY LINK <br /> f ❑LIFT STATION SIZE TYPE OF PUMP <br /> SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> [ LE <br /> ACH1N0 LINE 'NUMBER&LENGTH OF`LINES1 . <br /> s <br /> INFILTRATOR EHA'MBERS <br /> DISTANCE TO NEAREST::. WELL <br /> ^.FOUNDATION raR P <br /> 1 ILTER BED . WIDTH O ERTY LINE . <br /> LENGTH DEPTH „yf <br /> r :•DISTANCETO NEAREST WELL <br /> FOUNDATION [jPRppEItTY,I INE ) <br /> ❑°MOUNDED WIDTH <br /> LENGTH DEPTH Ir=k s <br /> DISTANCE TO NEAREST: WELL FOUNDATION I'1jOPERTY LINE <br /> '`0 SEEPAGE`PITS WIDTH .LENGTH ; <br /> DEPTH <br /> DISTANCE TO NEAREST;'WELL FOUNDATION .. PROPERTY LINE <br /> I '❑SUNIPS WIDTH LENGTH: DEPTH :e f <br /> DISTANCE TO NEAREST WELL FOUNDATION PROPERTY EINE. ` <br /> . - <br /> ❑DISPOSAL PONDS WIDTTi <br /> LENGTH DEPTH <br /> S DISTANCE TONEAREST'sW6LL EO[7NDATION PR2�PE$fYI rNE j"� } ' <br /> h)` <br /> I HEREBY CER'T'IFY THAT T HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SANJO) <br /> COUNTY <br /> ORDiANC TATE LAWS,AND ES AN EG LATIONS OF SAN JOAQUIN COUNTY. 7 I <br /> SIGNED. t'�p r <br /> TITLE. DATE �e <br /> � � 1 <br /> 0 <br /> YF ' 3f <br /> k <br /> , <br /> S . <br /> qq �. <br /> s <br /> ' k✓. Ii I <br /> '32,51- <br /> e <br /> I•,�jj°w.; ,.J 7 r 2N 7 I r7�'., <br /> :Y <br /> !Jto <br /> • Ti <br />- --_ -_ - - '". �I .f'moi, Yu Ki J r• :f'. _ ` <br /> R DE RTMEU E ONLY <br /> APPLICATION,ACCEM76D <br /> TANK,PIT,OR SUMP INSPECTED BY: <br /> FINAL INSPECTION BY: <br /> COMMENTS: <br /> RFCE[VFjJ�Y ,„ „DATE _ . P„E ']iT{SERVICE REQ.C $T,E,N <br /> INFO REM - _ - - SEPTIC�BJq ... ` <br /> 4731 39' <br /> f <br />