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LIQUID WASTE PERMIT <br />SAN JOAQUIN C'UUN 1'Y PUBLIC IIEALTH SERVICES ENVIRONMENTAL HEALTH DIVL!2 (4 FAR N QT I C <br />300 E. WEBER AVF ..I" FLOOR, STOCKTON. CA 95202 (209)168-3620 <br />RECD LJcz>'TEC7 <br />VON-RE//FCNDABLE PERM <br />IIT QEXPIRES 1 YEAR FROM DATE ISSUED FOR : i L_ - <br />JUR ADDRESS//� 1 Y/SGY rU ,�1s rCu/LL� _ e� • _ <br />CITYIZIP G%'intim% PARCEL SIZEIAPN— <br />OWNER NAME) a 1" ADDRESS <br />CITY'21P^:5,9/Yi L'. PHONE <br />CUV'I'RACTOO�P fir z.�J-�l�ir�T��n�L ADDRESS G <br />C.ITY(LIP LLJ31!l//' I'HoN'F-.,. <br />GEOGRAPHICAL INFORMATION: COORDIANTIS: X Y_ TOWNSHIP—R ANGE_SECTION__ <br />PERCTES'P(S) ( ) HOW MANY APPLICATION I: <br />TY PE OFSEP7ICWORK- bk NEW INSTALLATION ❑ RITAIRIADDITTON ❑ DFS'FRIICTTON <br />NNI'ALLATION WILL SERVE. 11RESIDENCE [ICOMMERIC'IAL C3OTHER <br />NUMBER OF LIVING UNITS:—L— NUMBER OF BEDROOMS--3—NUMBER OFEMPLOYEES: <br />�- <br />CIIARA(TER OF SOIL'1'U A f]FPI'il OF 3 PEh'I': ,7H6GL/f ,?,, PIT,'SUMP SOIL CHARACTER: 5 iVii rN NATER TABLE DE:PI'H <br />❑ SEPTIC 7ANK/GREASETRAP TYPE/MFG CAPACITY 14 64 UMBEROFC'OMPA�RTMEENTSs- <br />❑ PKC TREATMENT PLANT DISTANCE TO NEAREST: WELL 16t) r FOUNDATION �_' PROPERTY LINT, 25Z - _ <br />❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SLPARATOR (ENCLOSED SYSTEM) _ <br />%LEACHING LINE NUMBER M LFN(,TI I OF LINQ.S _31 VD , INFILTRATOR CHAMBERS <br />DISTANCE TO NEAREST: WELL. US r FOUNDATION 35'—' °ROPERTY LINE <br />❑ FILTER RED WIDTH LENGTH DEVI'll <br />DIS'IANCE:7O NF'ARFSI': WhI.I. FOUNDATION:_ PROPERTYLINE <br />Cl MOUNDED WIDTH LENGTH _ DEPTH <br />DISTANCE TO NL•ARLST W LLI. FOUNDATION PROPERTY LINE <br />r -SEEPAGE PITS WIDTH LENGTH _-. DEPTH <br />DISTANCE TONEAREST: WELL _/� r FOUNDATION 7'&' PROPERTY LINE <br />❑ SUMPS WIDTH LENGTH DEPTH _ <br />DISTANCE TO NEAREST. WELL FOCNDATION PROPERTY LINE <br />❑ DISPOSAL PONDS WIDTH LENGTH DEPTH _ <br />DISTANCETO NEAREST WELL FOUNDATION. PROPERTY LINE <br />1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND TIIE WORK WILL BE DOVE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDIANCES, ST E LAWS. D RUL AND REGULATIONS OF SAN JOAQUIN COUNTY, % <br />SIGNED: -� TITLE:'/: Pll � DATE <br />I I <br />T:biI <br />FOR DEPARTMENT USE ONLY <br />b <br />Or. APPLICA/TION ACCEPTED Y: _ DATE: <br />IC� <br />T . ', OR SUMP INSPECTED BY: <br />il <br />FINAI. IN.SFhCI'ION BY�{�_ <br />COMMENTS -Ira <br />PECODE SC AMOUNTCDE RECEIVED DY DATE PER?UTISERVICI-: RRUI'EST I SEPTIC IDI <br />INFO REMITTED SH <br />2 I 3 Z00O �Ctka> q/7/01 <br />0 2 S <br />N <br />v] <br />fl. <br />Eu <br />