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r SC <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBIC IIEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVL..3"FLOOR,STOCKTON.CA 95202 (209)46H-1420 -4 "'Tmi, <br /> I�EC:Y = <br /> ��QQ O -R V LE. C (R 'A 1 '1SS (/ <br /> JOB ADDRESS�l�."3;ZC?' di�6112 'IfiZ <br /> CITYMIP tel/t,U� PARCEL SfLFJAVN i+C2 !moi i-/il - <br /> OWNER NAME �,���/ /�s���F ADDRESS=��L'"�^'��/ <br /> CIlY21P_ L / _PHONE <br /> CONTRAC)'Oft F ice t_z'A!I % � r &A i ADDRESS�//�- <br /> PHONES =�r's T <br /> GEOGRAPHIC AL INFORMATION.COORDIANFITS: 7L__Y_ TOWNSHIP_RANG]^SECTIUN__ <br /> PERC TFST(S)I )HOW MANY APPL(CATTON#:— <br /> I YPE <br /> :_TYPE OF SEPTIC WORK: NEW INSTALLATION Q REPAIRMDDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: �BESIDENCE CI COMMERICIAL ❑OTHER T _ <br /> NU?TBER OF LIVING UNITS:(.._ NUMB/ER OF/4F.DROOMS: i NUMBER OF EMPLOYEES:`_ <br /> CHARACTER OP SOIL TOA DEPTH OF 3 FEET. /Yet✓���.��� P117SCMP SOIL CHARACTER: ��TO _ WATER TABLE DEPTH/�Z-t <br /> SEPTIC TANKIGREASE TRAP TYPE(MFO eJ192— _ CAPACITY F 7 ,NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL. FOUNDATION PROPERTY LINE . <br /> ❑LIFT STATNN SIZE TYPE OF PUMP SAND OTT.SEPARATOR(ENCLO.SEU SYSTEM). <br /> LEACHING LINH NUMBI-R do LENGTH OF LINES r Z 1NFILTRATOR CHAMBERS <br /> D(STANCE''TO NEAREST WELL_ i"?' rFOUNDA1ION_ 4[2_-*ft RTY LINE •I17> ' <br /> ❑FILTER BED WIDTH LENGTH _ DEPTH_ _ <br /> DISTANCE lb NEAREST:WELL_ _ FOUNDATION:_ PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> J DISTANCE.TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> AEEPAOE PITS WIDTH LENGTH _DEPTH <br /> DISTANCE TO NEA RESc: <br /> ['. WELL A114— FOUNDATION, 0' PROPERTY LINE V` C"' <br /> ❑SUMPS WIDTH LENGTH DEPTH _ <br /> DISTANCE TO NFARFST: WELL _FOUNDATION _PROPERTY LR$ <br /> ❑DISPOSAL PONDS WIDTH LENGTH _DEPTH <br /> DISTANCE TO NFARTiST: WELL ._,—FOI'ND.ATION--PROPERTY LINE <br /> - <br /> I HEREBY RTI T 1 HAVE PREPARED THIS APPLICATION AND TFIE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORD(ANLA W5,AND Riff A REGULATIONS OF SAN JOAQ!IN COUNTY. <br /> SIGNED /J �__ 1T(LE: DATE: <br /> Al I <br /> t- �F -} <br /> i <br /> +- <br /> 1� t <br /> I <br /> �1 L 4- <br /> '-{ TTL t- - <br /> �. F'OR OF.PART N'TUSE ONLY I <br /> APPUCATION ACChVTED BY T ;� L A�A.JL ___ ___DATE: `�f�1 <br /> TANK.PIT.URSUMP)NSP�. Y:_ _ DATE_ <br /> FINALINSP�rTION BY: 1 /-��--(J�y—_ ,,p �} <br /> COMMENTS: L� µ�I_ W F`�t� V�`-'�T N.. V�'( 4! <br /> If <br /> PP.CODE SC AMOUNT ('HECK RECEIVEDBY DATE PERMTTMERVI(:E REQUEST# SEPTIC IDM <br /> INFO RCM) <br />