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I, LIQt WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC.,.ALTH SERVICES ENVIRONMENTAL HEALTH DIVi$JQ,N� �� <br /> 304 E.WEBER AVE.,3"FLOOR,STOCKTON,CA 45202 (209)468-3420 G <br /> NON-REFUNDABLE PERMIT EXPIRES]YEAR FROM DATE ISSILED - R E-Q�"�F'-aAT-F <br /> JOH ADDRESS I -r 51 <br /> _ 1 CITYIZIP -MA C� _ _ _-.-_/� PARCEL SIZEJAPN <br /> OW,IER N-A.M��E ��I I I'�I IBJ '�' I��J rtO ADDRESS401 a <br /> CITYfZ[P:1 Iv�l fT LSF 5 3 4�n _ -__.__PHONE U3 — - <br /> x f <br /> CONTRACTORA}}FI f_ (�. AXJmfV 5W + A S S O(. I ML ADDRESS Z• <br /> CrtYJZIP PHONE_ <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP_RANGE_SSCTION - <br /> PERC TEST(S)`A HOW MANY -_ _ APPLICATION.: PA D-1 - !�l 3 ' <br /> i TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRJADDITION C3 DESTRUCTION" <br /> ' INSTALLATION WILL SERVE: ❑RESIDENCE %COMMERIC[AL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF ENIPLOYEES:---- <br /> CHARACTER OF SOIL TO A DEPTH OF 1 FEET: PIT/SUMP 50I1,CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANKJGREASE TRAP TYPFJMTFG CAPACITY NUMBER OF COMPARTMENTS O <br /> li lei^ ❑PKC TREAT' PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLINE <br />{ 1 C LIFE STATION SIZE. TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) t <br /> FFF y, <br /> ❑LEACHING LINE NUMBER&LENGTH CF LINES J INFILTRATOR CHAMDERS ISS <br /> DISTANCE TO NEAREST. WELL FOUNDATION PROPERTY LINE <br /> C FILTER BED WIDTH LENGTH � DEPTH <br /> DISTANCE TO NEAREST: WELL FOUN'DAT[ON', PROPERTYLINE <br /> 0 MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH - <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE__ �4 _ <br /> ❑SUMPS WIDTH LENGTH DEPTH f <br /> DISTANCETO NEAREST: WELL, FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS NVIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST; WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIPYY THAT 1 HAVE PREPARED THIS APPLJCATION.AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,S�TA'FE LA15'S,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />. SIGNED: Y`-� "' Ii l�r•l] TITLE: 11=.L Net<s:. rj N.'j',,,`. DATE: ---V2 '� . <br /> j RN <br /> NOW <br /> s� p gg <br /> 1 <br /> \�\�\ ...- <br /> ° } <br /> Kill wi <br /> ? "�"rIh'� \v \ \ ,1 ° ° Lvl ,.� t r axa f •r�A <br /> INN <br /> \ � \\\� a�m V i Lz.11 w t k <br /> G <br /> ��\���\ <br /> c <br /> art <br /> � f ' J A, x s ; s ' i ' p <br /> I ,, 4� d yy � <br /> 51 <br /> TF61#I3EpARThfEti71ISH'0NLY ,v <br /> `I APPLICATION ACCEM. D BY � ,><T - - i"1YR 7' ( DATE, -4 - <br /> "rAYK,PIT,OR SUNIF INSPECTED BY: "DATE: <br /> FINAL NSPECPIDN RY: <br /> COMMENTS: - <br /> il".' <br /> YECOPE SC AMOLNT CK.IRECEIVED BY DATE PERNIRlSERVLCE RSQLMST. SEMIC ID# <br /> INFO REIIIITED P.44H" 1' <br /> v'rc'f»' 7L;; <br />