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LIQU- -HASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBUC'*M.d-TH SERVICES ENVIRONMENTAL HEALTH DIVISION r� <br /> 304 E WEBER AVE.,3"D FLOOR,STOCKTON.CA 95m (2091468-1420 _ <br /> i / <br /> —7 //_n NON-REFUNDABLE PERMIT EXPIRES <br /> ^1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /CI 0lam/ C`Y1[ �(1 �� 7V�����l Il '/l_ i• Z= <br /> CITYmp L4=�2[s1(q csy"D PARCELS2&APN Z��l"y't4S�'i• l\I(I <br /> OWNER NAME•r)C-/�`t:�tn ILf erry]�("�i(4 I i C CI rty1 ADD ESQ I., �� I S r <br /> cTTY?JP f/"��.1( '7 Y1Z:•I:,!11i�/ k-l1 TL—,l—,,l PHONE l <br /> .� CONTRACTOR�\�:� C_- .ADDRESS], <br /> CTIYmPIrC' '\ :' PHONE- T_ 7- 70 <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP_R.ANGE_SECTION <br /> A� PERC TEST(S)S HOW MANY I APPLICATION 0: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDTTION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:— <br /> CHARACTER <br /> MPLOYEES:_CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHAR ACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANKIGRE.ASETRAP TYPE/MFG CAPACITY NUMBER OF COMPARTf"_NNAEI\ <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLINE RECFIN! <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) AUG 13 ZOO! <br /> ❑LEACHING UNE NUMBER&LENGTH OF LINES I INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE$AN JOAQUIN <br /> P08L1GREriCn+" " <br /> 11 FILTER BED WIDTH LENGTH DEPTH ENVIRONMENTAL.{f.1`� '•^" <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 /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> O DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> T DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> — <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANPES,STATE1 LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> T1TLE:AT l ! DATE: l(G- <br /> S;GNE <br /> 1 _ <br /> ri <br /> l� <br /> 1J7 <br /> R <br /> F <br /> 4' <br /> FOR DEPARTMENT USE ONLY <br /> APPUCATION <br /> 0• �' ]% -'� DATE: <br /> TAryK.PTT.ORAUMP PECEDBYI DATE_ <br /> F,NAL INSPECTION BY. <br /> COMMENTS <br /> PECODE Sc A . RECEIVED BY DATE PERNIMSERVICE REQUEST Y SEPTIC BJI <br /> INFO I, rT D —C.TS]?— -� �I <br /> a Cl t kms__ r rll" <br /> I I, <br />