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-70 LIQUID WASTE PERMIT <br /> J SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL DIVISION <br /> (,' <br /> 3N E.WEBER AVE 3"'FLOOR,STOCKTON.CA 9tND I1W1 <br /> JOB ADDRESS /y n/nl_L/n�/ ON!EPUNDABLE PERMIT EXPIRES 1 YEAR PI AjJ{�TfTI�$UED PwRCEL 9191: <br /> R.P clTvruP �0.-`��,-❑n l.�i( 9s./3�n3�?m1.Dmc eERMrt�. IIOO <br /> OWNER NAME Ile# 1Z ADDRESS ZM l�Y �9z)�Lo <br /> m Y?JP PHONE NUMBER <br /> CONTRACTOR /L/� A...LEE Z4 <br /> CITYZP O AA/T/GA PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X Y TOWNSHIP <br /> ----RANGE_SECTION <br /> p7EOFSEmCWORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION ❑ RESIDENCE NUMBEROFBEDROOMS: y <br /> ❑ REPMWADDITION O COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER_ <br /> NUMBEROFEMPLOYEES: <br /> ❑ ENGNEEREWALTERNATIVE - <br /> CHARACTER OF SOIL TO DEPTH OF)': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> RIB <br /> ❑,A� �PERCTEST(S) HOW MANY �j APPLICATIONN <br /> ePTICTANK TYPE/MFG f i� L, CAPACITY OD ROFCOMPARTMENTS_,�, <br /> ❑ GREASETRAP TYPEJMFG CAPACITY ROFCOMPARTMENTS <br /> r ❑ PKCTXPLANT DISTANCETONEAREST: WELL FOUNDATION_ HtOPERTY LINE - <br /> ❑ LIFTSTATION SIZE TYPEOTNAAP .SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> BOF LINES:�LENGTH OF LINES: .�.� <br /> >r Lewcx LINE �� OmRHLe TDnuRur: weu�T wuxDAnDN�� r9dPERx une�F <br /> INFLITRATOR CHAMBERS: z&T-Rgpk <br /> ❑ FlLTERBED WIDTH LEMODI DEPTR_ DeTUKtiONunuT: WELL EDUNDATKIN PRO TY LINE_ <br /> ❑ MOUNDED WIDTH LENGTH OEPTH DU.T.... E: WELL_ FWNOATION_ PROPERTY UNE <br /> N� <br /> ❑ SUMPS WIDTH LENGTH DEPTH ORANRTOXYRMT: WELL_ FWNDATION_ P0.0PFRTY LINE <br /> (3 DISPOSAL PONDS WIDTH_ LENGTH_ - DEPTH_ DufpCl TOnuRui: WELL FMNDATION_ PROPERTYLNE_ <br /> ❑ SEEPAGE PITS R DUJUTFA_ DEPTH_ nui.nC[TonuRCR: WELL FDUNDATIGN_ PROPERTY UNE <br /> - <br /> I HEREBY CERTxY THAT 1 HAVE PREPARED THIS APPLICATION ANOTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS <br /> AND RULES AND REGULATIONS OFSAN JOAQUIN COUNTY. <br /> M IMU 3JH ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLLEASECA�LL 1. ))A6S M23 <br /> R. SIGNED: TITLE: &. La/1WLY-" DATE:/ <br /> I I <br /> - - <br /> b I 1 <br /> —t <br /> N : <br /> DEPARTMENT USE ONLY <br /> AP-LIC ATNNACYFPTEDBY: _DATE: I 1+ AREA���EMPLOTEEIN � � OLttFILTyLLGGTION�� <br /> IN9pEREOBY:. �(�_ .//,^A��� DATE: �1.� �/ PERMITFINAXYES.ATE: INSPECTOR:- <br /> co T��s/ Z/'E'.�i ""n.Gyl--__fix-�sC �rwi7`� /`m <br /> �'_� ai .A• -sy �/is,-rte �^i hST.-.E_.w7 <br /> PE CODE Y O /AMOUN, T CHC A4H RERIVED DATE PEIIMRSER VRF PEQUESM NVOKG SEPIICIW <br /> R MI D Y <br /> RLVI6EDLI.H1 <br />