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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION, �7kf— <br /> 3 EIIER AVE.,3"D FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> t-SCJ F <br /> NO -RFFUNDABLF,PERMIT EXPIRES I YEAR FROM DATE ESSUE I <br /> JOB DRESS - <br /> CI'TYIZIP <br /> PARCEL SIZE/A`J <br /> PN <br /> OWNERNAME DDRFSS <br /> CITY/Zip <br /> PHONE I <br /> CONTRACTOR <br /> I <br /> CITY/Z[P C ADDRESS <br /> PHONE 6 —-. 701 <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X <br /> Y TOWNSHIP RANGE—SECTION <br /> PERC TEST(S) HOW MANY <br /> APPLICATION#; <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION <br /> ❑ REPAIR/ADDITION CI DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE <br /> 1 11COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEE{': <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MFG PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTHCA PAC[TY <br /> Q PKG TREATMENT PLANT NUM13FP OF COMPARTMENTS <br /> DIST'ANCL'TQ NEAREST; WELL FOUNDATION <br /> ❑ <br /> LIFT STATION SIZE ,- PROPERTY LINE <br /> 7'YE h OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Q LEACHING LINE NUMBER&LENGTH OF LINES � / V 1�� <br /> ! INFILTRATOR CHAMBERS {� <br /> ❑FILTER IIED WED'TFI <br /> DISTANCE TO NEAREST: WELL �. � <br /> FOUNDATION PROPERTY LINE <br /> LENGTH , <br /> f DEPTH <br /> i DISTANCE TO NEAREST: WELL <br /> FOUNDATION:LE <br /> ❑WEOUIVDED WIDTH �� <br /> LENGTH DEPTH PROPERTY LINE <br /> DISTANCE TO NEAREST: WELL FOUNDATION <br /> ❑SEEPAGE PITS WIDTHPROPERTY LINE <br /> LENGTH. DEPTH [SAY M E N <br /> DISTANCE TO NEAREST: WELL FOUNDATIONR E CE E V E D <br /> 13 SUMPS WIDTH �_. PROPERTY LlNE�_y <br /> LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELLNov r e F <br /> FOUNDATION PROPERTY LINE Nov <br /> ElD15POSALPONDS WIDTH LENGTH <br /> DEPTH SAN JOF',OUIN COUNTY <br /> DISTANCE TO NEAREST: WELLPUBLIC HEALTH SERVICES <br /> FOUNDATION PROPERTYIiIJ rFrq �TgL 1{E LTI{flEVI�' <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCI , T E WS,AND RU ES AND REGULATIONS OF SAN JOAgUIN COUNTY. <br /> SIGNED: <br /> TITLE:-6=mt t , <br /> DATE: <br /> Ix <br /> ]52' <br /> "u .ice - r <br /> -� PARCEL 29 '� ' ' -PARbTL 32 �� o n 1.o v,: o_ .• <br /> 2.15 ACRES N 12.47 ACRES - 4n '. n 0.n "+ - -s •'1� <br /> 352'14 r 3S8 e' PARCEL <br /> _ 166 166 2 40 ACRES - <br /> - d -_ '166• <br /> 7 1 <br /> �. _ <br /> p�pp - 447' <br /> ~PARCEL <br /> F 77� <br /> 2.32 ACR <br /> E 17 U2 <br /> 5 6 - - - _ <br /> - -rte--' <br /> n -- <br /> 176 - r , <br /> u <br /> m 74�, � _ 2�•- 286 <br /> �4 <br /> ® Or <br /> .4(r <br /> syr u a� u¢ PARCEL 20 PARCEL 18 <br /> I \/ P 2 i5 ACRES 2.05 ACRES <br /> 266' .__..-,...- _ .. <br /> 41 :A[ <br /> _ 0�u <br /> ' + 361' 177 176 - <br /> 7 76' 176' 176' <br /> 7308PROP'= <br /> ` - t� TY LINE <br /> Ova—— 1 TING ! <br /> 4 ER <br /> EXISTING <br /> _. <br /> ___ . EXISTING SOIL <br /> 60' - -'' _ - MOORLAND FAF <br /> EDMAROS ROAD - BLOCK NUM&EF <br /> FR DEPARTMF.,N7'USE ONLY <br /> APPLICATION ACCEPTED BY: I G•!./�'GO (� <br /> TANK,PTT,OR SUMP INSPECTF DY: DATE: <br /> FINAL INSPECTION a —DATE:- <br />�I- COMMENTS: <br /> 7Z-7-07ESC AMOUNT `d <br /> INFO ReMITTED CHECK#! RECEIVED BY DATE ~-- <br /> PERM[TlSERV10E REQUEST 9 SEPTIC ID# <br />