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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SER VICES ENVIRONMENTAL HEALTH DIVISION <br /> 301 E.WEOER AVE..? FLOOR.STOCKTON,CA 95202, l091465d40 <br /> NONIRFFL'ND NLP PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> CIT'ZP PARCELSI APN <br /> OWNER NAMEI�/1/��//^ x=_ AOGRESS,rA Z <br /> CIT'21P Z--. /��+ G p ` PHONE ;20 ? <br /> CONTRACTOR Lv�'�.L,��C //I/iTYS ADDRESS,/1/^'-� <br /> CTTYZP /Aa /l� �ifL �1� PHONE - ; —/%?�L <br /> GEOGRAPHICALINPORMATION:COORDIANTES X_Y_TOWNSHIP_RANGE_SECTION <br /> PERC TEST(SII )HOW MANY APPLICATION x: <br /> TYPE OF SEPTIC WORK: ❑ NEWINSTALLATION REPAIRIADDITION ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: ❑RESIDENCE ❑COMMERICIAL 13 OTHER <br /> LNUMBER OF LIVING UNITS:_ NUMBER OF EDROOMS:_ NUMBEROFEMPLOYEES�1-5U <br /> CHARACTEROFSOILTOADEFTHOF5FEET: PTOSUMPSORCHARACTER: WATER TABLE DEPTH_. <br /> ❑SEPTIC TANKJGREASE TRAP TMEM FG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCETONEAREST: WELL_ FOUNDATION_ PROPERTYLINE <br /> ❑LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES I INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST. WELL FOUNDATION PROPERTY LINEr,l`'ll <br /> LXFILTERBED WIDTH 1 LENGTH DEPTH .;E1 ., "I <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LbK I <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> 1 56 JUNUiIIJYlk <br /> DISTANCE TO NEAREST: WEFOUNDATION PROPERTY MI '. <br /> LL el <br /> mncl: <br /> HfNUl lem'n..,. <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH MWIRONIA NTA) <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> Y DISTANCE TONFAREST: WELL FOUNDATION PROPERT'LINE <br /> ` ❑DISPOSALPONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST. WELL FOUNDATION PROPERTY LINE <br /> )HEREBY CERTIFY,THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES, LAWS,AND ES AN GULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNEn // ,� �— TTLE�(J DATE <br /> L ' <br /> L1 <br /> ' — l — <br /> �F�U0.QLE'y[}.,RITiFM LV'E O4LV FY1A,1/�., <br /> APPIJCATION ACCFPTCDBY: DA� iITL.i <br /> L TANK IT <br /> OR SUbIP)NSP CTEDB Y �y\ <br /> .NAL PELTONBY <br /> COKIMEMS. ` Ci-Ec�c.E U/(, Y 11� <br /> YE CODE IC AMOUNT CXECK VI RFLEI\Ep pY DATE VE¢MRSFRVICE REQl1ESTM SEPTIC IDI <br /> INT-0 RtA1fiTFD USX <br /> r J . <br /> C <br />