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LIQUID WASTE PERMIT ) .70 <br /> SAN IOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 3061-WEBER AVE.,3°D FLOOR.STOCKTON,CA 95202 (209)468'3420 _Xp J4©1 O I 1� F <br /> IC NysFUN LR PFRs I'IRXP RES I YEAR FROM DATE ISSUED /-► <br /> JOB ADDRESSV <br /> CSTY;7.4P, PARCEL SIZFJAPNIZI . 1�L•S�_._ <br /> OWNER NAME ADDRESS - <br /> CITYILIP_ PHONE t� <br /> CON'IRACTOR—D� ADORFS� 71/X //� LOO A,_.... <br /> CITY/21P <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP--RANGE_.__S rfinON <br /> PERC TESTIS)( )HOW MANY APPLICATION N: <br /> TYPE OF SEPTIC WORK: �INSTALLATfON ❑ REIAIRIADOTLION (3 DESTRUCTION <br /> INSTALLATION WILL SERVE: IDENCE ❑ OMMERICIAL ❑OTHER_ <br /> NUMBER OF LIVING UNITS:. NUMBERS: 3 NUMBER OF kHPL.OYEES: _ <br /> CHARACTER OFSOILTO ADEPTH OF3FEET PTDSUMP SOILCHARACTERQ�� _le WATER TABLE DEPTH / <br /> EPTIC TANKIGREASE TRAP TYPE/MFG ei'�' i CAPACITY ))kg! NUMDFROFCOMPARTMENTS--Q— <br /> p PKC TREATMENT PLA:N1' DTS'CANCE TO NEAREtiT: WELL_ FOUNDATION.AD' <br /> _ PRdPERTY LIVE(fid <br /> ❑LIF)'STATION SIZE 711PE OF PU��{yjP ./S,A,ND,OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �CHING LINE NUMBER$LENGTH OF LINFS"_� $AdeZ INFILTRATOR CHAMBERS <br /> DISTANCETO NEAREST: WELL-4�'- --FOUNDATION 30_._PROPERTY LINE� — <br /> 17 FILTER HED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST.WELL FOUNDATION:_ PROPERTY LINE <br /> Q MOUNDED WIDTH__ LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FO ATION PROPERTY LINV. <br /> ' 3 <br /> gl SEEPAGE <br /> PITS WIDTH�, LENGIH DEPTH <br /> /� <br /> l`'' DISTANCE TO NEARM. WELI.r1'& FOUNDATION PROPERTY UNY_ y <br /> 13 SUMPS WIDTH LENG-114 DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION__ PROPERTY I-INF. <br /> CIDISPOSALPONDS WIDTH LENGI'il U£PTH <br /> DISTANCE TO NEAREST. WELL. _FOUNDATION_ PROPERTY LINE <br /> i HEREBY CEI! IFY HAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUM COUNTY <br /> ORDIANCBS, TATE) ',AND LIpl AND EGULATIONS F$O,y,WAQVINCOUNTY. <br /> SIGNED: _TITLE. DATE7-36'O <br /> _ 1 <br /> I <br /> +G <br /> I <br /> E kN,Ch <br /> Q <br /> FOR DYFARTMENT USF ONLY <br /> APPLICATION AC'CEP10 BY: °ATNF <br /> AN OR SUMP INSPECT' f,`fd..�L_.-_ A• =--'�--- <br /> FINAL INSPECTION BY: <br /> COMMENTS <br /> PF.CODE VSCAmouNr CIffCXM RECEIVEDBY DATE PRRMIT/SRR`/I(:EREQUGSTM SEPTM 130.#)NEO R6MnlED H _ <br />