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LIQUID WASTE PERMIT S�4 ��� amt .r1_iC <br /> SAN JOAQCIN COUNTY PUBLIC HF-AI-ITI SER )('FLS ENVIRONMENTAL HI Al.l7i DCVI. <br /> 304E.WEBER AVE.,3-FLOOR,S"TOC:KTON,CA 95202 (209)468-3420 <br /> NON-RFFUNDABLF PfiRMfT EXPIRES 1 Y'E`AR FROM LATE ISSL',> <br /> ]OB.AouRESS—__ z-„ � �5/�tP E'CTi�J,6�,1 <br /> — -------- — <br /> CITYliJP �!E'er� ✓ ;} PARCEL SIZE/AFN <br /> OWNFRNAME G�r�a <br /> CITY/ZIP _SHONE. <br /> C'ONTRAf.TOR __- ADDRESS,_.... G�-_--- ,/y <br /> CITY/L[P ...... �— --_. ------ ._ PHONE.. ..../..r�il...;lf_,C— _... ..... _.._.__ <br /> 011UC'J(APHICALINPORMATION:COORDIANTES: X Y__TOWNSHIP_RANGE_—S&:ITON________._ <br /> PERCTEST(S)( )HOW MANY _ APPLICATION N:_.. <br /> TYPL•OFSEPTTC WORK: f$NEW INS'UALLAT'JON O REPAIWADDHION ❑ DESTRUCTION <br /> INSTALLATION WILL SF,RV'F.; VV-ESIDENCE ❑COMMF.RKIAL 13 OTHER <br /> NRIMHI'sR UE LIVING UNITS:_ NUMBER OF BCDRUOM3t',7.r, NIIMBER OF EMPLOYEES:_ <br /> C.I IARA(TIW GF S(NL TOA D14MII OI;5 flit P: �4 100/3 42� PITISUh1P SOU.CHARAMER: W A9T R TABLE DEPTH_- <br /> ❑SEPTIC:TANKIGREASE.T(AP TYPFJMFG )9144 CAPACrIY_ fp NUMBEROFCOMPAI('1'MENTS <br /> r � <br /> 1:3PKG TREATMIiNTPLANT DiSTANCETO NEAREST: WLI.I.�f FOUNDATION PROPERTY LINE_. ^�'r <br /> �y❑,LIYTSTA'11ON S17.E_ TYPEOFPUMP SAND 01l.SHl'ARATOR!ENCLOStf)S1'STrNi). i <br /> Ly`�LEACHINO LINE NUMBER&LENGTH OF LINES��~�! � INFILTRATOR CHAMBERS <br /> // DISTANCE TO NEAREST: WELL _FOUNDATION FROPERTY LINE — <br /> ❑FILTER[iF'll W{UTH LENGTH DFPTII <br /> DISTANCETO NEAREST:WELL FOUNDATION: PROPERTY EINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH. <br /> DISTANCE TONFARCST: WELL FOUNDATION PROPERTY IJNE <br /> ❑SEWAGE PRS WIDTH LFCNGTH DEPTH / <br /> DIST,ANCETONBARPS11 WELL. F(RINDATEON PROPFKI'Y LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> UIST,ANCETONEAREST` Wfill- ---_ 147IJNUATION PROPERTYUNE <br /> 13 DISPOSAL PONDS WIDTH LENGTH _..DEPIN <br /> DISTANCiiTONBARIWI: WELL FOUNDATION _PROPERTY LINE__. <br /> I IIERRBY CERTIFY THAT 1 HAVE:PREPAXED THIS APPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCf-;S,STATE LAWS,AND RUL1;S AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: ./' _. ._:ITt18 ^ DATE: �'•.'�� c:/ <br /> � f <br /> .1 <br /> - I <br /> t t <br /> - I <br /> I - <br /> I I <br /> — RE <br /> ...... ......... .. ... .... _ _, 7 06 <br /> 1 AN JOAO N OJ TY <br /> _._._ <br /> .v A c ON <br /> MR DBMRTMENT I1NEUhLY <br /> APPLICATION ACCT ffED BY, <br /> DhI t, <br /> TANK,PIT.OR SUhIP INSFEC Y: ....... .................._...._.._ —�..___�_DA'Ih_—.. <br /> FINAL INSPIiCP;ON BY! J <br /> T[:C'(1OC SC AMOUh7 CHFC- RECUYGD DY DA'P); PFRAOTISC.RVrE REQWST A <br /> INF) Rr-%MTF.O i <br />