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L - <br /> LIQUJr WASTE PERMIT <br /> SANIOAQUINCOUNTYPUBL '_TH SERVICES ENVIRONMENTAL'68 0 <br /> L34DIVISI01�{,��+ <br /> 304 E.WEBER AVE,3'��OR,STOCKTON,CA 95202 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED It E.Cj ti._l`-`Y T <br /> JOB ADDRESSfJ 7 ..'+ �l��I n� I�/ t q- 1! 'te <br /> CITY/ZIPy�_ 1 3((1�`l'^�,� i 'PARCEL SIZE/APN n <br /> i OWNERNAME l�Cb -t.41�', ADDRESS L?bQ t <br /> CITY/ZIP ` / I r� \ PHONE F' <br /> CONTRACTOR 0'F l 1 1 i_ �' tt"i� �b1�.l iY'1 C Y I ��) ADDRESS �t� 1 l(,-1 In C V_\ <br /> CITYMP L d\ I� PHONE( C'r'( 36, T-370 / <br /> GEOGRAPHICAL INFORMATION:COORlDIANTES: X Y TOWNS HIP_RANGE_SECTION <br /> PERC TEST(S)W.HOW MANY l APPLICATION.: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL - ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS_ NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> i ❑SEPTIC TANK/GREASE TRAP TYPFMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG.TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> - <br /> O LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSIEM) <br /> i ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FWjER BED WIDTH LENGTH DEPTH <br /> t <br /> DISTANCE TO NEAREST.WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE PAYMENT <br /> 13 SEEPAGE PITS WIDTH LENGTH DEPTH RECEIVED <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH 1 <br /> DISTANCE TO NEARFST: WELL FOUNDATION PROPERTY LINE JOAOUIN COUNT <br /> ��ALTH SERVICES <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH _ _ENNRONMENTAL HEALTH DIVISIG <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE v Y <br /> i <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE K'ORK KILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCE LA AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: f�CR`�--�.�' TITLE: . +r DATE U .`J. <br /> C) riq- <br /> yeti" \t 7 <br /> I <br /> ' I <br /> ' I I <br /> • I i t 1 1 <br /> I <br /> /I FOR DEPAK YNIENT USE ONLY <br /> APPLICATION ACCEPTED BY:� - DATE: <br /> '7— <br /> r� 'TANK PR,OR SUMP INSPECTED BYDATE: <br /> FINAL INSPECTION BY: - <br /> COMMENTS: <br /> PECODE SC AMOUNT FB: RECEIVED BY DATE I PFRMR.'SERVICE REQUEST. SEPTIC IDM <br /> WPO RE"ITTED CASH• <br /> �i <br /> JIM c)-2-1 �`i�; c <br />