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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISIOf: <br /> 304 E.WEDLR AVE.,.1"FLOOR.STOCKTON.CA 95202 209' -34257 L <br /> NON REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATR ISSUMOU elL N„! <br /> 230Y S� <br /> JOB ADDRESS <br /> C1TTOP_ I k'O1G ..__ _PARCEL SI2FIAPN�Q` -�•• - `` �i\;C'� <br /> OWNERN'AME_�L� .lu _ADDRESS <br /> CITY2IP_ �� 1 - I, PHONE:83 3 7 7 7 7 ._.._.... <br /> _-_..�LSCD-OA P+.0 Mb A��___ADDRESS <br /> CONfRA('TOR 0 L <br /> \ <br /> PHONE--- <br /> GEOGRAPHICAL <br /> HONE GEOGRAPHICAL INFORMATION:COORDIANTFS: X.._..�.Y T0W^1SIIIP__RANGE_-_SECI'ION_ <br /> PERC TEST(S)( )HOW MANY _.__.__._ APPLICATION R: <br /> TYPE OF SEPTIC WORK: yy�IEW INSTALLATION RRPAlR1AUDITIOT�``e, DESIRIICTION <br /> INSTALLATION WILLSERVC;: oRESIDFNCE i3 COMMERICIAL Cl OTHER— <br /> NUMBER OF LIV[NCi L'NITS__ Nl1MBFR OF BEDROOMS- �2-. NUMBER OF EMPLOYL•ES:_- <br /> _ <br /> • WATER ABLE DEPTH <br /> CH RA, FSOILTOADEFI!1 OF}F'F:F'i; __`���_,��p,�ryA��T�/�S UMPSO(LC1[ARA/C�TER: - <br /> PTIC TAN REASE TRAP TYPUMFG�, L a f VL'�'CAPACITY I�`�' N�:MBER OF COMPARTS'E S� <br /> KG'IREATMENT PLANT DISTANCE TO NEAREST: WELL FOLINUATION PROPERTY LINE-- <br /> 0 <br /> INE , <br /> ❑LIFT STATION SIZE 'IYPFOFFIlMP•_-......._..,_,._SAND OIL SEPARATOR(ENCLOSE)SYSTEM) <br /> ❑LEACHMO LINE NUMBER R LENGTH OF LINES 1 INPICIRATOR CHAMBERS 1 -^ <br /> DISTANCETONE/AR�I'JT: WEI.1. FOUNDATION "ROPFRTY LINE <br /> FILTER BED WIDTH ..5_ I1:NGTH_, DE I = J L �J- <br /> DISTANCETO NEAREST:WELL I:NDATION: I f,Y PROPERTY LINE <br /> 0 MOUNDED WILT}I LENGTH_ T1F.TTH_ <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ��--ss C, <br /> 0 SEEPAGE PITS WIDTH LENGTH -DEPTH RCC NEP <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE— <br /> 13 0 SUMPS WIDTH LP.NO'IH DEPTH_ MAY 2 2001 <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> SAN JUS' F Vi"ES <br /> 0 DISPOSAL PONDS WIDTH I,ENGTI I_ UFI'1'H FN PUBLIC WE Li h <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPER <br /> TY�]1'JE�NT H�A�"IH i`lyl!;1f'N <br /> I HEREBY CERTIFY TH E PREPARR' IS APPLICATION AND THE:YORK WILL DE DONE IN ACCORDANCE WITH SAN JO QUIN COUNTY <br /> ORDIANCES,STAT ANDRU ND 114411LAT1.11 OF SA\JOAQuw COUNTY. <br /> SI"..,-... ./'!!s% TfI...��.............. ATE: <br /> 5 o essI <br /> - � I -F <br /> 5 I <br /> j - <br /> -- j <br /> T <br /> N ; <br /> I <br /> J i � <br /> 11e <br /> ul <br /> r <br /> r <br /> I i I <br /> �'OR UB�PIAIRTMRNT USR ONI.Y / <br /> APPLICATI(k <br /> DATE.: <br /> TANK.PIT,OR SliMP INS I't Y ' 1 <br /> FINAL L�SPCCI'I0.N DY: — <br /> sEPTIC ID. <br /> Pt..CODt j SC AMOUNT 'Ht(: RF.C'tIVhD RY Ui\]7: <br /> n'Hl RRMTTT ASH <br /> Z o [ a e ADO <br /> j <br /> b g 3 c jZ3 C�—e.P y- � <br /> Sri,, 1 <br /> �- <br />