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LIQUID WASTE PERMIT '", <br /> SAN JOAQjl.,rCOUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HL,..%TH DIVISION <br /> 304 E.WEBER AVE.,3""FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERM EXPIRES I YEAR FROM DATE ISSUED <br /> F` ;L.-' <br /> JOB ADDRESS <br /> CITY/Zip T-f o(-y, Of) 45 )77 PARCEL SIZEIAPN ;20-1149- <br /> OWNER NAME-----4 v*60 Vrw mr,t _----ADDRESS <br /> e - <br /> CITYIZIP _-PHONE <br /> CONTRACTOR AwUf sqv-N�f OSSOL —ADDRESSn-3 <br /> CITYIZI P d — PHONE 6W <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X— Y—TOWNSHIP_RANGE_SECTION— <br /> PERC TEST(S)*4XOW MANY APPLICATION#: <br /> TYPE OF SEPTIC WORK: C3 NEW INSTALLATION 13 REPAIR/ADDITION 11 DESTRUCTION <br /> INSTALLATION WILL SERVE: 11 RESIDENCE 11 COMMERICIAL Cp(C'THER 1ln-A.J4tl4Afte% .v <br /> --l"�d <br /> e i�pe�wc-�OS <br /> NUMBER OF LIVING UNITS:— NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: mi itec ( Or— I;t S <br /> Sep <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> 13 SEPTIC TANK/GREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENT'S <br /> Cl PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION— PROPERTY LINE <br /> 13 LIFT STATION SIZE_ TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> El LEACHING LINE NUMBER&LENGTH OF LINES 1 INFILTRATOR CHAMBERS ­-9-112�11 <br /> DISTANCE TO NEAREST: WELL—FOUNDATION— PROPERT <br /> 13 FILTER RED WIDTH— LENGTH— DEPTH RE DI) <br /> MA <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY&d 2­2aai <br /> 13 MOUNDED. WIDTH — LENGTH DEPTH ENVIROMWEIV 7. <br /> HEA <br /> DISTANCE TONEAREST: WELL FOUNDATION PRO&Rwp��� <br /> 11 SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL —FOUNDATION PROPERTY LINE <br /> 11 SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 13 DISPOSAL PONDS WIDTH LENGTH— DEPTH <br /> DISTANCE TO NEAREST: WELL — FOUNDATION PROPERTY LINE 0i <br /> 'By CE THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> I HERE <br /> ORDIANC CE THAT <br /> TA EPX.Ab�AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> rr <br /> SIGNED: 4,7t 1!10 --T,TLE6r4o DATE; '3 <br /> 4� <br /> R <br /> PCAA <br /> 1 11%W F,p 115 1 <br /> RAWAI: <br /> Ile <br /> 10 lyl <br /> El jWp L" H�L ILTh <br /> rJry <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY: DATE: <br /> TANK,PIT,OR SUMP INSY� -------DATE: 6u <br /> FINAL INSPECTION BY: a, wa <br /> commENT&A%Alo-3 ukowckt- :sn rgyvN"�tk k" I e <br /> u-:'kI,'%l% noA LIA kvl VW� Am yy% <br /> PECODE Sc AMOUNTEckw Fc <br /> REjvmay DATE PERMITISERVICF P SQUEST# SEPTIC ID# <br /> INFO REMITTED Qg;p- — — <br /> 512 g . <br /> 45ev"g o 91c) <br /> X CL <br /> 510 -ZOH—Jel(I <br /> Uts to C.') <br /> 414, 4PAaws 'ZXV­A.1­j --"o <br />