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LIQUID WASTE PERMIT <br /> SAN)OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> lIX E.WESERAVE.,3.O H.00R,STOCKTON.CA 95202 (209)4N34M // rr <br /> O .PERMIT EXPIRES I YEAR M DATE ISSUEDU,�O • <br /> JOB A10 <br /> DDRCSS I 1 <br /> CDYZP PARCELSILPJAPN O/ <br /> OWNERNAME FRED 'RT-VS" ADDRESS 15#yfAF <br /> CITYZP_ ` ff , PIIONE <br /> CONTRACrGB�OI.ALZ J <br /> A tmw tPMf 2h1C ADDRESS !SInS0 <br /> CITY?JP�Z Q 52AD PHONE 21 `A-TJ0515 . <br /> GEOGRAPHICAL INFORMATION:COORDIANTFS: X YTOWNSHIP_RANGE—SF.CIIIXS_ <br /> FERC TFVHS)( I HOW MANY APPLICATION P: <br /> TYPEOFSEPDC W(RIK: It NEWINSTALLATION ❑ REPAIWADOMON ❑ GESTEUCTION <br /> INSTALLATION WILLSERVE: F1RESIDENCE ❑COMMERICIAL C3 OTHER <br /> NUMBER OF LIVING UNITS:--L— NUMBER OF BEDROOMS:-4_ NUMBER OFF..MPLOYEES:__ <br /> CHARACTEROFSOILTOADEPTHOF3FEET��p 'I USUMP SOIL CH�A�RpA/C�TER: 5lWey _ WATER TABLE DEPTH <br /> IR SEPTIC TANK/GREASE TRAP TYPNMFG r 4L CAPACITYJi�NUMBER OF COMPARTMENTS._ <br /> ❑PKGTREATMENTPLANL DISTANCE TO NF:ARES I: WELL DAZ+ FOUNDATION {OJ PROPERTYLINF <br /> ❑UFT STATION SIZE TYPE OF PUMP SAND OILSEPARATOR(ENCLOSED SYSTEM), <br /> WLEACHINGLINE NUMBER&LENGTH OFUNES-3--I-kol INFILTRATOR CHAMBERS 99—_ /jam <br /> DISTANCE TO NEAREST: WELL FOUNDATION 4a_g1GPERTY UNE_ <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE'TO NEAREST: WELL F•OUNOAIIGN:_ PROPERTY LINE <br /> E3 MOUNDED WIDTH LENGTH_ DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNOA3HM' PROPERTY LINE_ <br /> RSPYPAGENIS WIDTH IinsPR '2k—DF.PFH ZSJ <br /> DISTANCETONEAREST: WELL 15OP4 FOUNDATION ?+T' PROPERTYLINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLINE <br /> ❑DISPUSALPONDS WIDTH LENGTH DEPTH__ <br /> DISTANCE TO NEAREST. WELL __FOUNDATION PROPERTY LINE <br /> 1 ENEMY CKRTIFY THAT I HAVE PREPARED THIS APPLICATION'AND THE WORK WILL BE DONE IN ACCORDANCE W ITN SAN JOAQUIN COUNTY <br /> ORDT I�9�lA/�j�WS, RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIG ED Gsw JS�.� TRIC 1ClfAITRAC.TO� DATE: I <br /> I <br /> E 1` <br /> i l 5 <br /> A <br /> J1! F rARTMdruse uNLr Z�.L <br /> APPIJ['ATKINAMEITmBY: R• 1 � DAiE71 <br /> TANK PITOR fI1MPM5P RDB ATE. <br /> F[NAL POPP,TION tlY: <br /> COMMFATI: w <br /> PE CODEg AMOUNT REC.BY DATE PIRMRISFAVICERHIUFST, 9PPITCd <br /> 1KPORR+A1fIlp <br /> i\ II 03lo t6 - /W92 <br />