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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COLNTY PUOLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE LN FLOOR•STOCK ION.CA 952D3(209)46$3420 <br /> Y�V// ON REFUNDABLE PERMIT EXPIRES 1 VFAfR FROM <br /> .DATE <br /> ^ISSUED <br /> JTIR ADDRESS_4-� •'' Q APN 01111 I/�.Cc� PARCEL SIZE: <br /> CITY/7.IP-�-jQ�JL1ON __d?6rI �. BVILDINC PERMIT R „ + <br /> ONTIEKNAMI: l??E.RRELL�R_I D,1�fZ r L DDRT.SS <br /> CITYJAA,P_ OULTO/�I 9t��0J PHONE NUMBER— f�AA� <br /> CONTRACTOR--D ADDRESSP•O.Box 1 fQt _ <br /> f.ITY't7JP!TU p 1�— [. 0- PHONE NUMBER xd c of lesiva <br /> GEOGRAPHICAL INFORMATION:COURDINATES:X, ,- _Y_- IOWNSHIP­RANGE SECTION <br /> TYPF.OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ZI RLSIDENCE N UM DER OF BEDROOMS: , <br /> O REPAIWADDITION ❑ COMMEKCIAL NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> — <br /> • ENGINEF.RF-D ALTERNATIVE <br /> CHARACTEROFSOIL ToDEPTH OF3': - PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTICTANK TYPE:MFG__ CAPACITY #OFCOMPARTMFhTS__ �1 <br /> U GREASETRAP TYPF-:MFG - .- CAPACITY-- - <br /> APACITY - - #OFCOMPARTMENTS W <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL--- FOUNDATION_ PROPERTY UAE <br /> W <br /> ❑ LIFTSTATION 517F- TYPE OF PUMP_- _ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Z <br /> ❑ LEACH LINE NOF LINES:� LENGTH OF LINES: DISTANCCTONURESY: WELL FOUNDATION PROPF-RTY UNE <br /> INFLITRATOR CHAMBERS: <br /> `) FILTER RED WIDTH- -_ LENG'I H_. DEPTH DISTANCE TONEAROT: WELL FOUNDATION PROPERTY LINE <br /> Q MOUNDED WIDTH LENGTH DEPTH DtSTANR TO VRARE4: WEII FOUNDATION PROPERTY LIVE_ <br /> fl <br /> ❑ SUMPS WIDTH__ LENGTH_ DEPTH DISTANCE TO NGRFST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ,_ LENGTIi DEPTHDLSTAVCETONEARRRT: WELL FOUNDATIONPROPERTY LINF _ <br /> SEEPAGE PITS N DIAME.ER OFlTH_ DI\TANcETo YLAMLST: WELL FOUADATION PROPERTY LINE_ <br /> 1 HERFBV CERTIFY'THAT 1 HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WTTH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS !� <br /> AND RULES AND REGULATIONS OF SAN JOAQVIN COUNTY. <br /> IN HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)168-3123 <br /> f —i <br /> SIGNED: TITLE: eI✓N�R _ DATE: �'�� <br /> 1 , <br /> I <br /> t <br /> -- —I ��_- - �-{----,--•'- - ' lig- i -}� -•- '- -•R�' � - - - --I - ��`-•— <br /> _ _ T —; <br /> - t - - - - <br /> FT <br /> - ! I <br /> D[PARTM6NTUSEONLY <br /> APPLICATION ACCEPTED BY_�V�+ DATE -X AREAEMPLAYEE D)I 1699._DISTRICT, _LOCATION , <br /> INSPEt-EDRY-_ ..--.- __— -. _DAT'E:—.. PERMTTFINALO YBSDATEI INSPECTOR: <br /> COMMENTS'-._ ..._. _ —.. <br /> PE CODE 5C.NFO AMOUNT CHECIU• 11 RECEIVED DATF. PERMITISF.RVIC.F.RF.OI:ESTP IVVOIl-FJ SEITIC IDA <br /> ALMIT'FD RY <br /> Z2z ,5z>r 2 <br /> N!'VINED atR11 <br /> - . <br />