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LIQUID WASTE PERMIT <br /> SAN IOAQU N COUNTY PUBLIC HEAVIIISERVIC.Fs ENVIRONMENTAL HEALTH DIVIS19�,� <br /> I pq <br /> 304 E.WEBER AVE.3"FLOOR.STOCKTON,CA 95202 (209)468-3420 <br /> NON-REFUNRABLK, F. 11'T EXPIRES I YEAR FROM DATE ISSUED <br /> ;OB ADDRESS <br /> —PARCELS171VAP14 <br /> CIT YlZIP <br /> OWNER NAME,��vW ZCR ADDRESS- 1 <br /> CITY/73F­ PHONE A <br /> CONTRACTOR m4aq, ADDRESS-1 i <br /> CITYM PHONE <br /> GEOGRAPHICAL INFORMATION:COORDIANTFS: X_Y—T0WNSHIP_--RANGf'._SEMON__ <br /> PERC TEST(S) [ )HOW MANY— APPLICATION#:--- - <br /> TYPE OF SRFrrIC WORK: E3 NEWINSTAIJ-ATION llrll�—AIRIADDITION Cl DESTRUCTION <br /> INSTALLATION WILL SERVE.' 112<.7-IDENCE 0 COMMERICIAL E3 OTHER <br /> NUMBER OF LIVM, UNITS: NUMBE Or-Hr R MS- NUMBER Of EMPLOYERS: <br /> ' BE <br /> CHARACTER OF SOIL TO A DEVal 0113 FEET4�e _e'Zge)o PI'I/SLMP SOIL CHARACTER5MC�C/�A WATER TABLE DFYI HZA�- <br /> I f <br /> 0 SEPTIC I"AN KIGR EASE TRAP T'YPFJMEU CAPACITY NUMBER OFCOMPARTNIENTS— <br /> E3 PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION— PROPERTY LINE— <br /> ULIFTSTATION SIZE— TYPEOPPUMP—SAND OIL SEPARATOR(ENCLOSED SYSTEM)- <br /> 'rACHING LINE NUMBER&LENGTH OF LIKES INMLTRATORCIIAMMERS/164F -3-O-q6 <br /> DISTANCE TO NEAREST: WELI FOUNDATION-zaZ -ROPERTY LM� <br /> E3 FILTER BED WIDTH— LENGTH— DEPTH <br /> DISTANCE TO NEAREST.WELL FOUNDATION:_ PROPERTY LIKE <br /> 13 MOUNDED WIDTH— LENGTH—DEPTH <br /> DISTANCETON,-AREST: WELL FOUNDATION PROPFRTYLINF.--- <br /> AAGE PITS WIDTH LENGT-H--DEPTH -C-A)IEEP DISTANCE TONEAREST: WELL FOUNDATION_92 PROPERTY LJNL Z <br /> 0 sumps WIDTII LENGTH DEPTH ­Q� <br /> DISTANCETONEARPSIT. WELL _FOUNDATION—PROPERTY LINE--- C11% <br /> ODISPOSAL PONDS WIDTH LENGTH—DEPTH <br /> MsTANCETONFARFST: WELL __FOUNDAITON—PROPERTY <br /> I HEREBY CERTIFY THAT I UA VE PRLF.P�S KIPPLICATION AND 7R WORK WILL BE IlONV.IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDI ATF.LAWS, AND <br /> D REGULATIONS OF SAN JOAQUIN COLNTY. TITLE'_ <br /> F F7 1 -1 <br /> 7 <br /> Fl 7-7)ATE I All I�Al <br /> + <br /> Ll <br /> 0-6 7 101 1 <br /> �e"t OKI <br /> zz <br /> FOR DEPARTNINNT USE ONLY <br /> APrUCATION ACCrPTUBY DATE;- <br /> TANK.16OR SUMP INSPECTED BY DATE <br /> FINAL INSPFL.'JIUN BY. <br /> Lr <br /> PF CODE sc AMOLNTRECEIVED BY DA I'E SEPTICID0 <br /> INFOR'w)TEn CASH . - , I <br />