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I <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HF.AI31H SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> (ly} 304 F..WEBER AVE 3"FLOOR,STOCKTON,CA 45202(209)4F:R-7420 <br /> 1 <br /> �f ''7�,J ( NOV•REI%UNOABLl:P,RMIT EXPIRES 1 YEAR FROMDATEISSUED ,g�, <br /> J08 ADORFSS Z2 7 / 1 1 �_ L 4�`� APN_ ti�CJ 7 `�J��% "� _ PARCEI-SS2E: l�I�+1'4 <br /> BUILDING PF.R.NiTa Y•� t d� � _ [� <br /> OWNER NAME G.�t..��C "C'4�TCP...,' 'i ADDRESS,^ Cc <br /> LI/ <br /> ('I7YlZIP- �f:� C c. _ t 1!Zi. PHONE NUMBER_ '?+ / rr 7 <br /> CO\7RACTON_—_QV�,�1 M ADDRESS_! <br /> I ' <br /> CITY/ZIP­ PIIONE NUMBER <br /> GEOGRAPHICAL.INFORMATION:COORDINATES.X _--_ _Y •_ , ___TOWNSHIP—,RANGt.._—_SECTION <br /> TVPF:OF SEPTIC WORX: INSTALLATION WILL SERVE;: NUMISFROF LIVING UNITS:_ <br /> jI�,NEW INSTALLATION i,RESIDENCE NUMBEROFSEDROOMS: 3 _ <br /> ❑ RL'PAIR(ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: 1,_� <br /> I ❑ DESTRUCTION ❑ OTHER __ <br /> O ENGINF,ERETYALTERNATIVE <br /> I <br /> CHARACTER OF SOIL TO DEPTH OF 3':_ PITlSUINP SOIL CHARACTER:_ W.ATER TABLE DEPTH:_ <br /> U PERC TEST IS) HOW MANY APPLICATION# <br /> jk.WXnCTANK TYPE:MFGje,L CAPACITY_ I2�J'79te #OFCOMPARTMFNTS__ <br /> U GREASE TRAP TYPClMFG CAPACITY #OFCOMPARTMF.NTS _ (� <br /> U PKGTJL PLANT DISTANCE TO NEAREST-. WELL___ FOUNDATION, PROPERTY LINE y N <br /> ❑ L16TSTATION SIZF— TYPE OF PUMP._ SAND OIL SEPARATOR(ENCLOSED SYSTEM)_�_�, <br /> I ) \I <br /> #OF LINES: LENGTH OF UNES: C .w !1) 1 r. + <br /> p--LEACH LINE DLRTANce'ro NEAR1wT: WELL FOUNDATION � PROPERTY LINE 140 <br /> INFLITRATOR CHAMBERS: 1� <br /> ❑ FILTER BED W1DIH IENGTH DEPTH DISTANCETONEAREST: WELL—— FOUNDATION—_ PROPERTY LINE 11� <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DM&T CETDpEARPST; WFLL FOUNDATION PROPERTY LINE <br /> + R <br /> -SUMP$ WIOTN_�- LENGTH iZ DEPTH I le DIFTANCeTfSNEARTAT: WELL FOUNDATION 4 <br /> 10r PROPERTY LINE It✓ <br /> S� DISPOSAL POWDS WIDTH LENGTH DEPTH DWTANCtTONEARECI: WFLL FOUNDATION PROPERTY LINE <br /> ❑ SCEPAG£PITS, 4 DIAMETER DEPTH msr.,hCe TO NEAp[AT: WELL FOUNDATION PROPERTY UNE <br /> 1 HEREBY CERTIFY TRATI HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> r 2J HOUR ADVANCE NOTICE REQUIRED FOR INSPECTION:S-PLEASE CALL(2119)462,U23 <br /> SIGNED:—,,-1. ' TITLE: BLw KGIr DATE: <br /> i ..., A. <br /> . k <br /> L.. <br /> i- <br /> - . ... a....; A ` <br /> J. <br /> 1 <br /> 4 <br /> _a <br /> ;. 1 .ti. ,.. �.. �.. <br /> DEPARTMENT SF: NI, p� <br /> APPLICATION ACCEPTED Y: _ D7ATE 4L d AREA 1I {_EMPL01'k:E IDv �p�u15TAl<'7LOCATIDN� <br /> INSPECTED BY: DATE:=/ ' /'`RMIT HNAL/YES DATE:__!�..INSPECTOR. <br /> COMMENTS �QQ4.IJ],�—_� <br /> I <br /> E('ODE aC INFO AMOUNT NFC A4i REL VCU DATE P(RMITISLRVICE KEOU'F.ST# INVOICE, SEPTICID, <br /> REMITI'EU RY <br /> —qZr 3 20 5(2—t !V-15—LoIt ED".Ul <br /> S � <br />