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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> ... 304 E.WEBER AVE 3S"FLOOR,STOCKTON.CA 95202(209146R-1420 <br /> I� <br /> /`/�'� �J/q� ON-♦R�EFJJ6. U��--NDA F.PERMI' F' PIRF.S 1 YEAR FROM DATE ISSUED <br /> RADDRESS E3 /-• 0C�^'G APN 6Q_— lq() — LI PARCELSIZE:�4� <br /> CITY/ZIP BUILDING PERMIT# <br /> L/NERNAME C ADDRESS <br /> CIT1'/ZIP PHONE NUMBER <br /> SITRACTOR R�D `GA L Z. ADDRESS <br /> ':;tag- <br /> �q/7�(, S (^ <br /> CIT'/ZIP PHONE NUMBER /`�V Cl / Y <br /> L:OGRAPIIICAL INFORMATION: COORDINATES: X Y_ TOWNSIUPRANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> I NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: �3 r <br /> REPAIR/ADDITION Cl COMMERCIAL NUMBER OF EMPLOI'EES: <br /> Cl DESTRUCTION El OTHER 4 <br /> I ENGINEERED/ALTERNATIVE <br /> CRARACTEROFSOILTODEPTHOF3% PIT/SUMP SOIL CHARACTER: _ WATER TABLE DEPTH /3D ' <br /> FERC TEST(S) HOW MANY APPLICATION# <br /> Y! SEPTIC TANK TYPE/MFG CAPACITY #OFCOMPARTMF.NTS R <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> PKGTX PLANT DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> r � <br /> ❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) �. <br /> LEACH LINE #OF LINES:--L LENGTH OF�D DLWANCETO NEAREST: WELL.; FOUNDATION 14W PROPERTY LINE�� <br /> INFLITRATOR CHAMBERS: <br /> C <br /> r FILTER BED WIDTH LENGTH DEPTH_ DUTANCETONUN"M WELL_ FOUNDATION PROPERTY LINE <br /> I� MOUNDED WIDTH LENGTH DEPTH_ DLATANCETO,NEAREST: WELL_ FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DISTANCETONEARENV WELL_ FOUNDATION PROPERTY LINE C� <br /> 1< <br /> I DISPOSAL PONDS WIDTH LENGTH DEPTH_ DISTANCE TO NEAREST: WELL FOUNDATION PROPERI'1'LINE <br /> M/ / / <br /> SEEPAGE PITS # DIAMETER DEPT11u S DLttANCI TO NEAREsf: WELL FK� FOUNDATIONS PROPERI'1'LINE <br /> �� <br /> HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY(ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI UM 24 HO JR,ADVV EQUIRED FOR INSPECTIONS-PL ' SE CALL(�J23 <br /> :NF.D: e sTITLE: ` <br /> DATE: <br /> 11 <br /> J <br />