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6. LIQUID WASTE PERMIT <br /> SANJOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 301E WEBER AVE;,2°0 FLOOR,STOCKTON,CA 952M (209)068-M20 <br /> NON-REFUN BMIT EXPIRES I YEAR FROM DATE ),( ��a L(�`/.�y(����J�• �t. <br /> TOB ADDRESS1►a 19 s• L_OC'�L(_G C( �Y / G (=C�•��� _ � <br /> CITYMP GARCFL�SlMAPN <br /> I OWNER NAME ADDRESS <br /> UTYSL 1 V =�C <br /> - CTTYZP �fA � PHONE <br /> CONTRACTOR <br /> �JVL '/C�y ADDRESS/Z/ r�pL(A'I .� <br /> CITYZP_-✓' - (rr `S - PHONE 6 6 &K <br /> GEOGRAPHICALINFORMATION:COORDIANTES: X_Y TOWNSHIP�IANGE_SECTION <br /> PERC TESTIS)( )HOW MANY APPLICATION N: <br /> TYPE OF SEPTIC WORK 545,W <br /> INSTALLATION ❑ REPAIRIADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: DENCE ❑ 14MUICIAL ❑OTHER <br /> ` NUMBEROFLIVINGUNPB:_/ �NUM�YBEROFBEDROOMS: NUMBEROFEMPLOYEES:_ <br /> CHARACIEROFSORTOADEPTHOF3FEET:-/� PITISUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> IGy3� <br /> 5 CTANKREASETRAP TYPFJMFC(�LML J�c fO d-- CAPACITY-Z& NUMBER OF COMPARTMENTS <br /> ❑PKGTREATMENTPLANT DISTANCE TO NEAREST: WELL,�S—� FOUNDATIONS PROPERTY LINE 7D f <br /> ❑LIFTSTATION SIZE TYPEOFFUMP SANDOB.SEPARATOR(ENCLOSEDSYSTEM) <br /> "MaCHINGLINE NUMBER&LENGTHOPl-lM5_ // INPILTRATORCHAMBERS <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY L YMENT <br /> r ❑SEEPAGE PITS WIDTH LENGHTDEPTH D <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY PER-O- LLUU7101 <br /> ❑SUMPS WIDTH LENGTH DEPTH r��--�� 811 �� <br /> DISTANCETONEAREST. WLL EFOUNDATION PROPERTY OApUIN COUNTY <br /> 13 DISPOSAL PONDS WIDTH LENGTH DEPTH NVIHONMENTAL HEALTH DIVISION <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 /> SORDIANM,IGE! r L VB,AND ULES i FSAN JOAQUIN COUNTY. S <br /> Z- �/ V <br /> G <br /> V ILI <br /> ,J <br /> ru <br /> V <br /> r <br /> o <br /> o0 <br /> ` o <br /> FOR SPAR USE ONLY J'\ <br /> A,PIK 1A ACCEPTEDBY: l )MTF% i/ <br /> TANK.PR.ORSUMP WSPECI®BY: GATE <br /> ` MAL MSPP.CIION BY: <br /> NMMEYR: <br /> PE CODE SC AMOUNT CHICK, RECEIVED BY GATE PERAIRISF3VNS lEOV6TY SEPHCBL <br /> INFO PEM CASH <br /> it5l ! a3-a% OO 7- <br /> 5 <br />