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q4o 6 -J 9-4:�--=> <br /> .� LIQUID WASTE PERMIT <br /> SAN,EOAQUIN-t--OUN'fY PUBLIC HEALTH SERVICES ENVIRONMENTAL His.—FIA DIVISION � <br /> 104 E.WEBER AVF.,3k'FLOOR,SE'OCKTON,CA 95202 (209)466-3420 <br /> l NON-REFUN'DABLI{PERMIT EXPIRI±S 1 YEAR FRONT UATE?ISSUED <br /> 3013 ADDRESS <br /> -� _FLS 6 vi - <br /> Ci'1'1'all, ��� t� PARCEI-SIZOAI'N 1� <br /> OWNER NAME -�.T I ��ti'J.1-� ADDRESS u SC L-,�L J l J,�` <br /> CITY/LIP ��J IC r PHONEf R L.� -� <br /> CONTRACTOR C(:A ADDRESS <br /> ('I'I'YI'l,II' 191ONE �f_�� l J L) <br /> fI <br /> iiLOCiRAPIIICAL INI'ORMA'I'ION: COORDIAN HS: X Y TOWNSHIP RANGE; SECTION <br /> i PFRCTEST(S) ( ) HOW MANY APPLICATION#[: ,�/ <br /> TY PF OF SEPTIC WORK: LJ NFWINSTALLATION L7 REPAIR/ADDITION ,rx DESTRUCTION <br /> II <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMLRECIAL ❑OTHER <br /> e, <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: L"�—' PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> II_ <br /> SEPTIC TANKIGRF_ASETRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS r <br /> D PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> k <br /> i <br /> 0LIITSTATION SIZE 'I'YPl3OPPLIMP SAND OIL SLI'ARATORWNC'LOSEDSYSTEMI <br /> 0 LFAC:ILING LINE NIfMIS1iR ti LI?Nl Cll U! i.INIs5 _/_ INFILTRATOR CIIAMBERS <br /> E' <br /> DISTANCE FO NI:ARL,ti f: WELL FOUNDATION !'ROPERTY LINE <br /> ❑FILT'kiR BE3D WID"111 LING I'Il DIA 1'II <br /> E` <br /> DIS'I'ANCE'I-O NFAf2E5"I': QUELL FOUNDATION: PROPERTY LINE <br /> O MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINErt11�� <br /> D SEEPAGE PITS WIDTH LENGTH DEPTI I i1 <br /> I DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> d SUMP5 WIDTH LENGTH DEPTH (� <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE V' <br /> q I <br /> D DISPOSAL PONDS WIDTH LENGTH DEP`T'H <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1-HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE LAWS,AND R 1 ES AND REGUNS YS JOAQUIN COUNTY. <br /> SIGNED:�, 1 ( .7, V'- �J <br /> TITLE' f�{' 1J 1 ,tI` f7�Z- DATE. <br /> ------------ <br /> L- J } <br /> I I <br /> ,f a :.,. ,..... <br /> I ! I l <br /> l , <br /> — <br /> i <br /> Ii I <br /> F <br /> I i <br /> I I I <br /> * I <br /> €I I .... I <br /> 1 <br /> I I <br /> I <br /> NLY [�J r}- <br /> APPLICATION ACCIiPTIiD 9Y: DATE: -r r Y . <br /> it <br /> TANK,PIT,OR SUMP INSrlx.,I-ED BY: DATE:_ <br /> i FINAL INSPECTION BY: .vGil <br /> COMMENTS: r � <br /> PECODE Sc AMOUNT ' RECEIVEDBY DATE PERMITISERVICE REQUEST 1$ SEPTIC IDN <br /> i y INFO Rcwt-P CASH <br /> ' i' ''�' � la �12e�4o2.1v •7,3.x. <br /> I- <br /> l; <br /> I <br /> l e_�eeY 1/� <br />