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7z6611 <br /> LIQUID WASTE PERMIT -" /- <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE.,3R FLOOR,STOCKTON,CA 95202 (209)468-3420 <' <br /> JAN 0 2 2001 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED . <br /> /// <br /> CITY2� T(� •. D'�u _' fA EL SIZYE/AAPN/ <br /> IF <br /> OWNERNAME, L /J / <br /> ADDRESS <br /> CITY/ZIP W t /���YL CA , 13 PHONE 16 e I <br /> ADDRESS <br /> CONTRACTOR <br /> CITYPHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X_Y_TOWNSHIP_RANGE_SECTION_ <br /> PERC TEST(S) ( ) HOW MANY APPLICATION%: -J <br /> ❑ NEW INSTALLATION 11REPAIR/ADDITION RQL DESTRUCTION <br /> TYPE OF SEPRC WORK: <br /> INSTALLATION WILL SERVE: ❑RESIDENCE <br /> ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: <br /> PIT/SUMP SOIL CHARACTER:- WATER TABLE DEPTH <br /> [I SEPTIC TANK/GREASE TRAP TYPE/MFG <br /> CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT <br /> DISTANCE TO NEAREST: WELL_ FOUNDATION PROPERTY LINP <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_ <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE - <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL <br /> FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH - <br /> 1 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> / <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL <br /> FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL <br /> FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLI ON AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> LpfiDIANCES,ST N OF SAN JOAQUIN COUNTY. "V , '- v <br /> TITLE: DATE. / <br /> SIGNED: <br />