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i <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION y`y.+. <br /> 3041-WEBER AVE..3"FLOOR,SiOCKTON.CA 95202 (209)468.3420. �^-..:! �-;;t~'� . <br /> r'.},'_. <br /> NON-M,'UNDAB E PERMIT EXPIRES II YRAR PROM DATE ISSUED <br /> JOB ADDRESS Q 5t '• " ,Q 1 <br /> CJTYMP Zoi_�r>c iLr� PARCELSCLFIAPN <br /> OWNERNAME :aAl /J 4.s;„ ADDRESS latter <br /> CITYFIIP PHONE 707-SUy <br /> I <br /> CONTRACTOR lr-+ /s� ytT __ADDRESS C1)f- ZMAI! <br /> CryalP / PHONE MGA-�D?7 _ -.— <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNS HIP_RANGE_SECITON <br /> PERC TEST(S)( )HOW MANY_ APPLICATION A: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION W,REPAIRIADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE aCOMMERICIAL 0 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:— NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACI'L:'R_ WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GR$ASE TRAP TYMMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WE•I.L FOUNDATION PROPERTY LINE_ <br /> ❑LIFT STATION SIZE ._TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 19LE.ACHING LINE NUMBER&LENCTH OFIINES _j_!� INFILTRATOR CHAMBERS , <br /> DISTANCE TO NFAREST: WELL 270 '_FOUNDATION l.fr PROPERTY LINE A57D r" <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCET[O NEAREST:VrW.L FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH! LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> A PITS WIDTH tea„ LENGTH—DEPTH - <br /> f ttt 1 <br /> ' DISTANCE TO NEAREST: WELL 1� 7'! <br /> . FOUNDAON Z Y♦ PROPERTY LJI"IEE�__ <br /> 0 SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> O DISPOSAL PONDS WIDTH LENGTH DEPTH �7 <br /> DISTANCE.IO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I RAVE PREPARED THIS APPLICATION AND TI IF.WORK WILL BE DONE IN ACCORDANCE WM SAN.TOAQUIN COUNTY <br /> OLLDIANcz%517wykTg LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. , <br /> SIGNED: TI L.E:4�216 DAlT_ <br /> I <br /> i <br /> I <br /> I I <br /> I I <br /> � I <br /> 1 <br /> t I <br /> 1 A <br /> i <br /> i <br /> FOR D¢PARTMPaVT USE ONLY <br /> APPUCATIONACCFPTED BY:_ DATE <br /> TANK,&IbR SUMP INSPP.CTPD BY: • VGJt+yg♦'�—Z-� <br /> Txs.--vr-- <br /> FINAL INSPECTION BY: <br /> (J.7"N'! COld1REMS, l S 1m <br /> .]. TI afA V4 -b I 1 = u <br /> PECOM SC AMOUTRECEIVED BY DALE PERMTTISER.IP)L7C <br /> CE REQUEST SLD1 <br /> UNTO R0437 ED CASH <br /> 25o <br /> -LOD Ciso l - 4 <br />