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LIQUID WASTE PERMIT <br /> Sn .JAQUINCOLINTY ES PUBLICHEAUTHSERVICENVIRONMENTAL HEAI:I. .ISION <br /> 309 E.WEBER AVE.,3"°FLOOR,STOCKTON.CA 95202 (209)468-3420 <br /> NON RFFUNDABLE PERMIT 6MRFS I YEAR FROM DATE ISSUED <br /> JOB ADDRESS '7UCX-7 G[ ':�(_�-Lc4a q' /l r�//,�� <br /> CITY2IPsl:�i4jd./ PARCEL SIZEAPN <br /> OWNER NA_MF,.2a__ ��''�V,�t�ADDRESS f�L ✓/ /��f( 3 <br /> CrTym ✓ PHONE <br /> CONTRACTOR e ! ADDRESS��Q^yr� ..�/� <br /> CITYlLIP <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP_RANGE--$LCFION__ <br /> PERC TESTS)( )HOW MANY ��yy APPLICATION I <br /> Ix <br /> F. <br /> ._- <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION REPADUADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE' 13 RESIDENCE ❑COMMERICIAL 13 OTHER <br /> NUMBER OF LIVING UNITS:-,L NUMBER OF BEOROOMS:j— NUMBER OF EMPLOYEES:__ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: l�fi�Y Prr/SUMP SOIL CHARACTER: _ WATER TABLE DEPTH <br /> ❑SEPTIC TANKtGREASE TRAP TYPFIMFG CAPwC1TY, u2O NUMBER OL'COMPARTMENTS r-- <br /> 13 PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY IJNE <br /> ❑LIFT STATION SIZE TYPEOF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM)_ <br /> LJEACHING LINE NUMBER&LENGTH OF LINES��Z _ INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST. W ELL I<t-,)/ FOUNDATION_ •d f 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 /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Q DISPOSAL PONDS WIDTH LENGTH DEPTH _ <br /> DISTANCE TO NEARFST: WELL FOUNDATION PROPERTY LINE <br /> .--.Yr HEREBY CERTI THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DINE IN ACCORDANCE WITII SAN JOAQUIN COUNTY <br /> ORDIANCES,S LAWS,AND R }:S A REGULATIONS OF SAN JOAQt;IN COUNTY. <br /> SIGNED: TITLE:, DATE: <br /> CDP' <br /> L <br /> G <br /> T <br /> S J A <br /> P AU 11 Ek CE <br /> FOR DEPARTMGYf USEONLY <br /> APPLICATION ACCPPTM BY: DATE r�- <br /> TANK.PR.OR SUMP INSPECTED BY: _DATE: <br /> FINAL INSPP`DO BY: AA / 2-� <br /> L'OMMENi S: <br /> PECODE SC AMOI.OJr RECEIVED BY DATE I SEPTIC IDN <br /> INFO RdMIT1FA CASH <br /> �{,i. +o ;" r ip X538 tb. ala k0 -7 <br />