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LIQUID WASTE PERMIT <br /> / . SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE..3"D FLOOR,STOCKTON.CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1(72Ora E/ L beviti (? /� <br /> CITY2IP_ ./��L 1 {J PARCEL SIZE/APN FJ <br /> OWNER NAME IL1(�LS.�c?twnRrt-JI(LI ADDRESS 13310 � . KAe,,-4-lew+•ayt LY1, <br /> 'J CITY/ZIP L � . 9'So2 4�0 PHONE <br /> CONTRACTOR ADDRESS <br /> CITYMP PHONE <br /> GEOGRAPHICALINFORMATION: COORDIANTES: X Y TOWNSHIP--RANGE-SECTION <br /> PERCTEST(S) (VORHOW MANY APPLICATION k: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICAL ❑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 TANKIGREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE-- <br /> 13 LIFT STATION <br /> INE - <br /> ❑LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> C <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS (� <br /> DISTANCE TO NEAREST: WELL FOUNDATION DROPERTY LINE Ll <br /> J <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE 01 <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYWNE-------PAYMENT_-PAYA AENT I <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH �IRECEIVED <br /> 8 C C <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE- <br /> 13 <br /> �r� (� <br /> ❑SUMPS WIDTH LENGTH DEPTH APR 19 2 <br /> C <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> SAN JOAQUIN COIJN <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH PUBLIC HEALTH SERVICE <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ENVIRONMENTAL HEALTH DIV <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STA ffyyLAWS,AN LES ArD REGULATJONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: �.SC I TITLE: C-%VLI- fo� <br /> 12mY ROAD <br /> I j <br /> 7-t-5 7- <br /> r <br /> I� 1 i <br /> I 1 �OROft <br /> e�� <br /> i <br /> PARLEL 7 I� <br /> 4- ACRES 67 I I, <br />