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LIQUID WASTE PERMIT `` / <br /> / SAN JOAQ�COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL,t Dir <br /> 304E.WEBER AVE..3RD FLOOR,STOCKTON,CA 95202 (209)469-3420 ( /.� p} iA•A � <br /> n /N N-RgMF [!!ABLE PElR-M�IT EXPIRES I YEAR FROM DATE ISSUED [= -1L.S i a�1 ,. )` <br /> JOB ADDRESS /(7-ALT <br /> ''76 t60 / L i V et, _aY M1[V 'Qr <br /> CITY/LIP l�LT PARCEL SIZE/APN 01 -���,I <br /> OWNER NAME r / Sam FtV1nQ hil(LI ADDRESS X3310 R.�{ Ie.�Y'd�. <br /> n <br /> CITY/ZIP LA/L R C�� TO PHONE <br /> CONTRACTOR ADDRESS <br /> V CITYIZIP PHONE _ <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP_RANGE_SECTION <br /> PERC TESTIS) (/HOW MANY_3 APPLICATION#: <br /> TYPE OF SEPITC WORK: ❑ NEW INSTALLATION ❑ REPAIRIADD17ION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF'3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL_ FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE yl <br /> ❑FILTER BED WIDTH LENGTH DEPTH V <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE----------Pn ^ACC" (_A 1T <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH RECEIVED <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH APR 19200 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 8ANJCUNI <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH PUBLIC HE�ALIIN SERVICE <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ENVIRONMENTAL HEALTH DIV I <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY C� <br /> ORDIANCES,STAT LAWS,AN LESA REGULAT NS OF SAN JOAQUIN COUNTY. _ <br /> SIGNED: TITLE: C%VtL- VE - DATE: <br /> i <br /> L$tY ROAD <br /> Ij- • Ttsr� mom" <br /> 91• � <br /> P' <br /> �k I NILSEN I I <br /> PARCEL.eRO" I <br /> MARY <br /> 1Mq <br /> FAIPCEL 9 <br /> lI e. A4RE5 ewon <br /> 4' ACIGPS� i <br /> N FOR DEPARTMENT USE ONLY ---_ DATE: <br /> APPLICATION ACCEPTED BY ; U_IQ� <br /> TANK,PTT.OR SUMP INSPECTED BY: p DATE' <br /> FINAL SPECTION BY: <br /> M °z I ' pnacc, -M-sr Noy I nnkee� 3 TW Ii-"Gr <br /> 4 PECODE SC AMO I Kd RECEIVED BY DATE PERMTDSERVICEREQUESTS ' OR SEPTC �_ <br /> INFO R.M <br /> 4222. 5 82I � 414e 5R00 '1g57: <br />