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LIQUIT' WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC, TH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 309 E.WEBER AVE.,3RO+WR,STOCKTON,CA 95202 (209)468-3420 24 HR M OTT I C <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED R E Q U E� -TEE ID <br /> JOB ADDRESS —q2 I'�I T.�� () IT C''/'ll( j-)U-< <br /> CITYIZIP P 1 f ✓l l'f j ' j :�6'�— •PARCEL SIZFJAPN <br /> <rr <br /> OWNER NAME Pr flL 1 l P(t <br /> CITY2IP )( y` 1' '��C�1 PHONE :)r e" 7�1 <br /> CONTRACTOR N�F/1 ' .•� \' I(�,( J'1 1�f� ADDRESS ;3 ' /'.; //tt) <br /> CITY2IP /:r`1 �{f� PHONE ' [�l/ L�" ? ,V I <br /> GEOGRAPHICALINFORM.ATION:COORDIANTES: X Y TOWNSHIP_RANGE_SECCTION <br /> PERC TEST(S)V'HOW MANY p APPLICATION k L 0 —01- 77 <br /> TYPE OF SEPTIC WORK: ❑ NEWINSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMFRICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:— <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> ❑SEPTIC TAN KIGREASE TRAP TYPEJMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PRG TREATMENT PLANT DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LITE 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 FOUNDATION PROPERTY LINE * \ <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NE.REST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH - DEPTH <br /> - DISTANCETO NEARFST: WELL FOUNDATION PROPERTY LINE <br /> L <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,SP \ITE LAWS. ND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. y N <br /> SIGNED:/ I ri(zitz Y7 I I�/I �TITLE:�iPc�IcU C;� DATE: <br /> 1 1 <br /> Y <br /> i <br /> 1 2 3 8 4 5 6 <br /> " APPROXIMATE SCALE: O �.Q4L1'e!�s <br /> .re*i 1 Inch=1,000 feet <br /> - - _S/� EP,A MEN;7'USE ONLY V' <br /> APPLICATION ACCEPTED BY: /ZIPr_ Ate' O <br /> TANK,PIT,OR SUMP INSPECTED BY: DATE: <br /> FINAL INSPECTION BY: <br /> COMMENTS <br /> PECODE SC AMOUNT K/- RECEIVED BY DATE PERMIT/SERVICE REQUEST. SEPTIC llR <br /> II REMITTED <br />