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3 LIQUID WASTE PERMI" .-- <br /> `/ SANJOAQUINCOUNTY PUBLIC HEALTHSERVICESENVIRONMENTALHEALTHDIVISIE) 4 S'+Ft 1'\I(D <br /> 304 E.WEBER AVE.,3°O FLOOR,STOCKTON,CA 95202 .-, (2J9)463-3420 R.61 t)u l=—s-T-v_rD <br /> F` NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED F u n .A{j, <br /> JOB ADDRESS 7•.T / J •�G /y�y /J G [- ,J. ' I{� v F->T" G N{i r <br /> CITYZP ,Sr�l.�-or-) PARCELSIZE/APdl ' 1 " <br /> OWNERNAME rloh LF ADDRESS <br /> CITY/Zip /( PHONE / <br /> CONTRACTOR c ak- r, S C." C.- ADDRESS <br /> CITY/ZIP �,Il <br /> y J - 1�3 T-1- PHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIPRRNGESECTION <br /> 'PERC TESTIS).( ) HOW MANY APPLICATION M: <br /> TYPE OFSEPTIC WORK: , Ir NEW INSTALLATION ❑ REPAIWADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:/ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: �L-�� ',_PITSISS.�UMP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> E3 SEPTIC TANK/GREASE TRAP TYPE/MFGI �/C CSA CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL_ FOUNDATION_ PROPERTY LINE C! <br /> ❑LIFI'STATION SItE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> id LEACHING LINE IviBER&LENGTH OF LINES�/�� INFILTRATOR CHAMBERS � <br /> DISTANCE TO NEAREST: WELL A I FOUNDATION ?ROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTHIJ��(Mr �Nr <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ED <br /> r• Lr <br /> 8 SEEPAGE PITS WIDTH LENGTH (.. DEPTH /y JJ ,`� � (1 <br /> DISTANCE TO NEAREST: WELL ,�FOUNDATION — -:Y— PROPERTY LINE .S: li Cfl <br /> ❑SUMPS WIDTH LENGTH DEPTHIJ'!�COL!N <br /> l K Ty <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT JhIHAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE LAWAND RULES AND REGULGTa9N5'oYSAN JOAOI TIN COUNTY. <br /> SIGNET DATE: e-, <br /> Iz� eft V' <br /> ra 4c, <br /> c u t: O <br /> IN j. N O .,4 V` 7'... :1-1 ,9 <br /> 1' =i <br /> ve <br /> fr✓i f.7�1�..� <br /> N '4 <br /> 'i'v1 ysy-r <br /> FOR DEPART ENT USE ONLY ^1 <br /> APPLICATION ACCP MAY: DAM:ti`) 2U- V I <br /> TANK.PIT.OR SUMP INS P BY DATE: M <br /> FINAL INSPECTION BY: <br /> Comm P.NiS: <br /> -2$ OU SM'J4D oRREeT t sys7t.4 s w pJ rF, Q <br /> ,Beak J3JAiD/ 13ct Ajr M? SC. £ P <br /> PECODE SC I AMOUNT CHECK X/ RECEIVEDBY DATE PERMIT/SER (' UESTN SEPTIC IDN <br /> INFO R-MRTED CASH <br /> U (J <br />