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r LIQUID WASTE PERMIT LCU! ate© <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> yr 306E WEBER AVE,3"FLOOR,STOCKTON,CA 952M (20)B 8-3428 244 R M NOILREFUNDABLE .PT v HR "OTIC <br /> B YFR M D TE ISSED r TE ID <br /> j 11('7h plc T� `�ici tc �r uEeNwu ((�/ <br /> IDE AOST (Uroy+ lnce6/,�� Sel <br /> tl. DR843 N <br /> —s ns9- lla -c �tJ rtia <br /> CITY�P ( Y\ S'T�4 PARCELSIZE/APNZ <br /> I� Ir- n -I-P rtn Qry (A <br /> OWN�NAME,SIRY, \VYP JiJ'PU .ADDRE35on <br /> �.(11 IdFu I <br /> nTY 'S In!7'r Y <br /> PHONE 476-�/(fC0 <br /> MR ADDRESS <br /> t In. ���.••• ( •N <br /> co <br /> ` Civallp (j� ���}-//1 1I J PHONE <br /> GEOORAPNICAL INFORMATION:COORDIANTES: X_Y.TOWNSHIP_RANOE---SECTION_ <br /> I i �I APPLICATION A^ <br /> FERC TEST(S1 HOW MANY <br /> T EOj.swc WORK, VV❑"` NEW WSTALkATION - ❑ RFPAIR/ADDRIONI ❑ DESTRUCDON <br /> y 1�TIOTrNM1LLT5ERV1. ❑RESIDENCE 7 7f IOCOMMERICAAI. P r o". <br /> .. I — <br /> 1 4 NUMBER OF EMPLOYEES:_ <br /> OFLIYING UNITS:_ NUMBER OF BEDROOMS:_ <br /> C RACTER OF SOIL TO A DEPTH OF 3 FEET PTDSUMP SOIL CHARACTER: WATER TABLE DEPT_ <br /> ❑ISEPDCTANKMaREASETRAP TYPF/MPO CAPACITY NUMBER OF COMPARTMENTS <br /> - <br /> [3 PKG TREATMENT PLANT DISTANCETONEAREST: WELL— FOUNDATION— PROPERTY LINE- <br /> 13 LIFT <br /> INP❑LIFT STATION SIU_ TYPEOFPUMP SANDOILSEPARATOR(BNUL MSYMEM) <br /> ` ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATORCHAMBERS <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTYLINE <br /> ORLTERRED WIDTH LBNOTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> Y <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCETONRAREST: W11L FOUNDATION PROPERTYLINE <br /> ❑SEEPAGE PITS Wib131 LENGTH DEPTH �II <br /> r DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE V <br /> O SONIPS WIDTH LENGTH DEPTH <br /> DLSTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> 12 DISPOSAL PONDS WIDTH LENGTH DEPT <br /> R. C <br /> y DISTANCR TO NEAREtt: WELL _FOUNDATION PROPERTY LINE , <br /> 1 niEReeY 6$ HATI HAVE'MfA ED1HIS APPLiCATJONRNUkH6WORK 1pLL BEIION6[N`ACCORDANCE WITH SAN JOAQUINCOUNTY <br /> OIGNED CPS�AWS.7NDJTUIJFfC&1N,ID�EGULATIONs OFsA�NIJOAQUIN COUNTY. <br /> SIGNED l/DII l/ 1,(/1"`� � TITLE: I P DATE: <br /> N <br /> r_ <br /> .. V <br /> 1 <br /> JAU <br /> - HT <br /> N, <br /> E—T . <br /> R DEPARTMENTOSEONLY <br /> r APPLICAT)ON ACCEPI'EOBY: <br /> TANY..PR.OP SUMPMSPECTEDRY: GATE <br /> MNAL W4PECTION BY'. <br /> COMAW TS'. <br /> 4� <br /> PECOOE SC AMOUNT RECEIV®'BY RATS PRRWT/SEKVICERE VEST♦ SPITR <br /> W <br /> r J <br />