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LIQUID WASTE PERM ''�~�~((']] <br /> G/ /� SAN 10 Q IN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTEgLTH DIVlS10N_�� �' <br /> 1 L Nw5 5 .WEBER AV 3° FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> - SS���1/// ./ - N BL, ERMIT EXPIRES I YEAR FROM D TE ISSUEDCITY/ <br /> JOB ADDRESS .A Ty�Fr R«� <br /> OWNS IP 14 I'24D -2l <br /> PARCEL SIZP/APN_ <br /> OWNER NAME PARCEL <br /> 3ZZ Sin <br /> ADDRESS eJ <br /> crrrmP_�1/�ah+i�c-r.+� 9 -�'� <br /> CONTRACTOR �h� PHONE��_�.3�/�v� k <br /> 9 <br /> CITY/ZIP ADDRESS y� �✓+ 'CA q 5ZOS PHONE) 94.8-1-34 <br /> GEOGRAPHICALJNFORMATION: COORDIANTES: X <br /> Y__TOWNSHIP_RANGE_SECTTON_ <br /> PERC TESTIS)�A HOW MANY <br /> �,/ <br /> — APPLICATION 9: <br /> TYPE OFSEPTIC WORK: )K NEW INSTALLATION <br /> ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 13 RESIDENCE �( <br /> COMMERICIAL E3 OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: JAI <br /> CHARACTER OF SOIL TO A <br /> NUMBER OF EMPLOYEES:, <br /> DEPTH OF 3 FEET; si-�p� <br /> PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPFjMFG <br /> CAPACITY NUMBER OF COMPARTMENTS <br /> 11PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL <br /> FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 13LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 13 FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑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 <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCTS,STA A ND ONS OF"SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE: I- `e�r—~DATE: <br /> V <br /> At 'At <br /> z 1 ii•. r 5 <br /> ..KLO Rx S COAD I/67I n <br /> y ieL i1ID, <br /> .3 �GY/cis/ u <br /> 23 <br /> POR. SW. 1/4 SEC. 14 IS. R.6 <br /> 1. SCALE Q � <br /> SAN JOAOU(N IN COUNTY (�� -'��Y� [ <br /> - I <br /> ASSESSORS MAPS u <br /> n <br /> � v <br /> FOR DEP TMENT USE ONLY <br /> Leiv� 6 DATE: <br /> APPLICATION ACCEPTED BY: <br /> / <br /> TANK.Pa.OR SUMP NSP <br /> FWALINSPE4TIQjPB� A T� <br /> COMMEN*—" _. <br /> f <br /> PE CODE SC AMOUNTHECKM RECEIVED BY DATE PERMITISERVICERBQU 0 1/ SEPTIC �+ <br /> INFO REMTITED <br /> �a U3 3i <br />