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LIQTWASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLf ALTH SERVICES ENVIRONMENTAL HEALTH DIV1St�t�� H �-r-'�J <br /> 304 E.WEBER AVE.,3"°FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> RFHCsUE-,-rEa <br /> ..j <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED r--, <br /> / t �.'�.._.J 6"T /•fin.L <br /> JOB ADDRESS Ll171 /t f <br /> OWNER NAME' � .. 1, i�-,.: .. / �• 1.: ',v i (_. ' ;/` 7 I 1CIL <br /> CITY/ZIP K„Jr!�T✓i PARCEL SIZFJAPN <br /> .i C.L r1 ADDRESS <br /> CITYIZIP_.•._L t ( \ �..,-�� J / �' .., .-� [� PHONE <br /> t <br /> CONTRACTOR 17, i'C/I I_.'. �•-}7�t �ir�i f�.I 1. `A S_S L r. ADDRESS �-� �� 4 �' t;.Y� L12 ' <br /> _ <br /> • CITY2IP �i!i 1• PHONE <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP_RANGE_SECTION C <br /> PERC TEST(S)� HOW MANY A_ APPLICATION X: !-A •I 1 C. d- <br /> TYPE OFSEPTIC WORK: ❑ NEWINSTALLATION Cl REPAIR/ADDITION ❑ DESTRUCTTON <br /> S <br /> INSTAL[,ATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER �--• <br /> -- NCM1fLELQF LIVING UNIT,$: .._. _NUMBER,OF BEDROOMS-, NVMBEROFEMPIAYEE$:_ <br /> CHARACTER OF SOIL TOA DEPTH OF FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPFJMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> .� ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS S , <br /> DISTANCE TO NEAREST: WELL FOUNDATION °ROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH G� <br /> i DISTANCE TO NEAREST:WELL FOUNDATION: - PROPERTY LINE <br /> ❑MOUNDED WIDTH, LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ��a7 <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH G' <br /> DISTANCE TO NEAREST: WELL - FOUNDATION PROPERTY LINE <br /> ❑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 /> 1 HEREBY CERTILY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> z:wEORDIANCE !AND lf-L,LAT I <br /> YSAN COUNTY. <br /> _ DATE:TITLE: t <br /> a ac w s[c v <br /> I IDD <br /> �.�,•� os-iso-�i �5 <br /> � t , � - ,��� s ee•xnrr i. �- s n•x'n>•f se - w..r ���'"� <br /> s ur•>~u•[ owro PARCEL"S <br /> PMCEL"5 __ -_ ,sn.c rigvrntt.s[s i )"' .�__• <br /> DWVI [6 D[ <br /> rw ix�i ws o[urzo <br /> B <br /> PARCEL•4 t <br /> Y 9 wy� 8 SAN <br /> PUB <br /> coENNRON <br /> H LO� u ao <br /> . •' ,o <br /> PARCEL Z" <br /> {,. sclTel' iw.w n� E <br /> a' z m r I <br /> ,•p PARCEL 'I" v, , <br /> 1I( 1�. <br /> I <br /> S S J I O.I RIGHT-OF-WAY j )me ` e roaw I'`•._%li <br /> - - - <br /> 1 <br /> APPLICATION ACCE�fi.BY�J-1tA O \� ( �1L' - DATE:�"• IIA•+l/ <br /> -TANK,PIT`OR SUMP INSPECTED�B� DATE, <br /> r IN kk• <br /> it <br /> FINAL INSPECTION BY: <br /> COMMENTS: <br /> PECODE SC AMOUNT CHECK#./ a m <br /> RECEIVED BY DATE PERMIT/SERVICE REQUEST M SEPTIC u <br /> INFO REMITTED <br />