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E 1 <br /> LIQUID WASTE PERMIT <br /> _..,:JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL REAL., JIVISLON <br /> 304 E WEBER AVE..3MO FLOOR.S'I'OCKTON,CA 95202 (2091458-3420 I <br /> NON-REFUNDABLE PERMIT EXPI RFS I YEAR FROM DATE ISSUED <br /> JOB ADDRESS3Z-7-1 I H- _ <br /> CITYIZJP 1'ARCE[.SZ <br /> Qu)7APN " ~ - V <br /> UWNER NAME. —IGfi�F"�� • IyJ AADRF,55�� 7 {,LI�`�C.✓—w <br /> CITYfz) PHONF <br /> CONTRACTOR icy i" �L -Y SII ADDRESS-- PAYMENT <br /> RECEIVED <br /> -- <br /> CTTYfZIr PHONE -OCT <br /> 11 g y <br /> GEOGRAPHICALINFORMATION'COORDIANTES: X Y 70WNSHB'_RANC,F—SECTION OC 1ff++T 3 1 2000 <br /> P&RCTEST(S)[ )IOW MANY__ APPLICATION q: �.,�A"� IQAQUIeV I;OUNTY <br /> TYPE OF SEPTIC WORK: )!f/NEW INSTALLATION ❑ RFPAIRIADDMON ❑ DESTRU PUBLIC I IF,AI TH SrFMCFS <br /> r"�.. I,SMOFNTA; IIfA?TfiCI I$rZf: <br /> INS'J'ALLATION WILL SERVE: ❑RESIDENCE �JMMERJCIAL ❑OTHER <br /> NUMBER OF LIVING UNITS_ NUMBER OF B£OROOM,S: NUNSBEROF> _MPLOYEGS: - <br /> CHARACTER OF SOIL TO A DEPJ'H OF 3 FEET. PIT/SUM P SOIL C <br /> //-H <br /> -��A�RA�CTER: WATER TABLE DEPTH <br /> SFPTIC TANKIGREASE TRAP TYPERdEO �,Q� ,._.—CAPACITY •/rv"' NIJMBER UT OOMPARTM�VTS Z— <br /> ❑PKGTREATMENTPLANT DISTANCETONEARESS: WELL__ FOUNDATION PROYERTYLINE <br /> ❑LIFT STATION SIZE T'YPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> RJy l <br /> ACI IINO LINE NUMBER&LENGTH OF LINES g- ltL INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL ZZO(f FOUNDATION 7 LID/—PROPERTY LINE GO! <br /> 0 FJL'IFR BED WIDTH I,ENGTTJ DEPTH__ <br /> DISTANCE TO NEAREST. WELL_.. FOUNDATION- PROPERTY LINE <br /> ❑MOUNDED WIDTH I,F:NGTH DEPTH <br /> l DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLING <br /> SEEPAGE YI'1S WIDTH MjAI&Ff} 12— DEPTH <br /> r1,,�{ f <br /> DISTANCETONEAREST: WELL __ =COUNDATION/ PROPERTY Uls, l)O0 f <br /> 0 SUMPS \4TDTH LENGTH[ DEPTH <br /> DINTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSALPONDS WIDTH LENGTH DEPTH_ <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVK PREPARED THIS APPLICATION AND THE WORT{WILL BE DONE'IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANC$5, ATE WS AN RUL AND IIFGULATIONSOFSAN JOAOUINCOUNTY_ <br /> / SJGNE TITLE�' .�lArl'!/SYJ ! / DA'1'�lCJV�//y .I7, <br /> 4 <br /> } A y <br /> _ I <br /> r <br /> MLO C,Lf I I <br /> l <br /> Ll I <br /> pit <br /> I <br /> I <br /> I I <br /> HPEPARTMEN k NLY <br /> APPLLCATIONACCEPTEDflY I _,__. DATE U G <br /> ��� <br /> TANK,PIT,oR SUMP 1NSPEC///TF_DEYTE: <br /> :T1 _- DA _/ <br /> FINAL INSPECTION BY'. L 1 <br /> COMIAI <br /> PE CODE SC AMOUNT CIIEC RF(Xw] ;UBY DADS PFRMITISFKVICE REQUEST# SEPTIC EN <br /> INFO RCM D H <br /> /-6 gS; D C <br /> 2q iha -v ,c,tr L <br />