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f <br />{ <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> f 304 F_WEBER AVE.,3R°FLOOR,STOCKTON,CA 95202 (209)468-3420 w <br /> �a <br /> NON-RE ABLE PERMIT EXPIRES I YEAR FROM DATE ISSUEDfl-T <br /> JOB ADDRESS <br /> /� <br /> Q fr <br /> CITYMP� CA ✓ -PARCEL SIZFJAPN O6 I <br /> i OWNER NAMJEkDDRESS , V <br /> CITYIZIP 7 PHONE <br /> i y CONTRACTOR M� 44 1 IC ADDRESS r L:, 1�.1 11��"/ <br /> 4,66 -96 <br /> CITY/ZIP 4: / 5PHONE 0-7 <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP_RANGESECTION <br /> PERC tEST(S) ( ) HOW MANY APPLICATION#: <br /> r- TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION REPAIRIADDIT ON DESTRUCTION `` {{``� <br /> 1 INSTALLATION WILL SERVE: ll RESIDENCE ❑COMMERICIAL �OTHER4� 4`�.i4� <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:a NUMBER OF EMPLOYEES <br /> 9 r CHARACTER OF SOIL TO A DEPTH OF 3 FEET: Lam-.A-- PITISUMP SOIL CHARA=-,TTS I`� WATER TABLE DEPII + <br /> 1 , XSEPTIC TANKIGREASE TRAP TYPE/MFG CAPACITY 60 0 NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION_ PROPERTY LINE_ 1 O <br /> d LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I <br /> LEACHING LINE NUMBER&LENGTH OF LINES� /—� INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL 70 t FOUNDATION PROPERTY LINE <br /> ' f <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> i <br /> q DISTANCE TO NEAREST: WELL - FOUNDATION PROPERTY LINE <br /> SEEPAGE PITS PITS WIDTH LENGTH DEPTH _22 <br /> j� DISTANCE TO NEAREST: WELLQ FOUNDATION � PROPERTY LINE 40-+ <br /> r 13 sumps WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREB ERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN CCORDANCE WITH SAN JOAQUIN OUN <br /> r^-'+ ORDIA T W5,Ai1jD R S b L TIO S OF SAN JOAQUIN COUNTY. {�� <br /> `� SIGNED: •�•J1 � TITLE:° DATE:� �� <br /> ..f -- <br /> -- r <br /> gtt- <br /> f <br /> f i <br /> 1 <br /> C <br /> I - <br /> Ff <br /> -l4l <br /> - I , <br /> 010 <br /> Tla <br /> 1_�4 <br /> I <br />