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„ . LIQUID WASTE PERMIT . - �'�] ,t�' <br /> SAN JOAQUIN-,COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL I It-ml-TH D1xsa4 HR MC)-Fl(:-"E <br /> 304 E.WEBER AVE.,3"b FLOOR,STOCKTON,CA 95202 QW)408-3420 Fll=— ¢C�u E STE <br /> NON-REFUNDABLE,PERMIT EXPIRES I YEAR FROM DATE ISSUED /21,]� <br /> JOB ADDRESSl c:)N S <br /> t. ... <br /> CITYIZI P� PARCEL SIZUAPN <br /> 1 OWNER NAME -I ?;'4e U C-07 <br /> 5 ADDRESS S Ci.CJL��/L <br /> +i CITY/ZIP �f/1'TG�Gi4 PHONE �J ' <br /> ! <br /> CONTRACTOR ADDRESS <br /> CITY/ZIP G PHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y - TOWNSHIP RANGE SECTION, <br /> i <br /> FERC TEST(S) ( ) HOW MANY APPLICATION 4: <br /> T'YPEOFSEPTIC 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 /> C14ARACTF-R OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: SA�� WATER TABLE DEPTH <br /> ❑SEPTICTANK/GREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKC;TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Cl LIFT STATION SIZE TYPE OF PUMP SAND�OIL SEPARATOR(ENCLOSED SYSTEM) J_ <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES� — /� INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL y� FOUNDATION PROPERTY LINE <br /> ❑FILTER RED WIDTH LENGTH DEPTH <br /> p DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> +! ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPBRTYLINE <br /> 1 ❑DISPOSAL PONDS WIDTH LENGTH DEI-I-H �[ <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE cj <br /> 1 <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE LAWS,AND RUL S AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ' SIGNED: « .��C TITLE: DATE: � n <br /> 6D wv& <br /> 6!7 <br /> Ii <br /> 1 <br /> 7 <br /> :t:..x•...- n.�... °��,rs err,�. — :� � a. r - <br /> -�. <br />' lµ � 'Aµ'1'N i1N'1'USF � L <br /> APPLICATION ACCEPTED BY: L1�DATE: <br /> TANK.PIT,OR SUMP INSPECTED BY:/�/j� ..l{ 1. DATE(S Y cJ d <br /> FINAL INSPECTION BY: r4^��' -----_ .._- _.uV N C�uN S <br /> COMMENTS: <br /> P QN�EN . <br /> PE CODE SC AMOUNT CHECK 401 RECEIVED BY DATE PERMITISERVIC6 REQUEST N SEPTIC 11340 <br /> INFO RCMITTED <br /> duo [ (X6 6 623 3 <br />