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-i <br /> LIQUID WASTE PERMIT <br /> SAN)OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 303 E WERER AVF..,3`R FL.00R,SfOCKTON.CA 9520: (209)46,4-142U <br /> _ NON RFPUNDABI E PERMIT EXPIRES I YEAR FR0.QUAI.E 1SSliED <br /> -,JOB ADDRESS <br /> fiTY21P �! 9��A Z _PARCEL S�JAPN <br /> / OWNER NAME 14 Ajk\ �� ADDRESS _. -- <br /> CITY/LW_ PIIONE - <br /> CONTRACTOR ADDRESS — <br /> CITY(LIP PHONE <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP_RANGV _SECTION_— <br /> . PERC TESTIS)I )HOW MANY APPLJCA"IION k: <br /> TYPE OF SEPTIC WORK: ❑ NEW iNSTALLATION O REPAiR1ADDITION OUT OF S6WICs <br /> INSTALLATION WILL SERVE ❑RESIDENCE ❑COMMERICIAL ❑OTHER_ <br /> NUMBER OFLIVINQUNITS:_ NUMBER OF BEDROOMS NUMBER OFFMPLOYEFS:- <br /> CHARACTER OF SOIL TO A DF.PIN OF 3 FEED PI'USUMP SOIL CHARACTER: — WATER TABLE DEPTH-- <br /> 13 SEMC <br /> EPTH^_❑SEPTA TANK/GREASE TRAP TYPE/MPG CAPACITY—NUMBER 0'COMPARTMENTS <br /> ❑PKG TREATMENT PLANET DISTANCE TO NEAREST: WELL FOUNDATION— — PROPERTY LINE— _. <br /> ❑LIFT STATION SIZE,_ TYPE OF PUMP__SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMRER&1.ENC17Ti OP LINRS _J INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WEII FOUNDATION -_— PROPERTY LINE. <br /> ❑RLTER BED WIDTH , LENGTH_ ._ DEPTH <br /> DISTANCE TO NEAREST WELL FOUNDATION:_ PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NCARESI W'FLL FOUNDATION _PROPERTY LINE- <br /> 0 SEEPAGE PITS WIDTH LENGTH_-Y-_ DEPTH_ <br /> DISTANCE 1'0 NEAREST': WELL FOUNDATION PROPERTY LINE <br /> Q SUMPS WIDTH I_ENGI H 01-PTH <br /> DISTANCE TO)NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LEN(3IH DE}'TH <br /> DISTANCElONEAREST: WU- I, FOUNDATION— PROPERTY LINE <br /> 1 HP:REBY CEATIFY THAT I HAVE PREPARED THIS APPLICATION AND"FHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY <br /> ORDIANCES,STA WS,A ULES ANU NS OF SAN)OAQMN COUNTY. <br /> SCGNEiY DATE, <br /> 1 L <br /> lK <br /> NZ <br /> IT- 1 --4 L-4 - <br /> FO LPA "MI:h SY.IMiLY f�+/�7 � <br /> APPUCaTION AC(eFrED BY:_ �•[ � DATE: <br /> TANK P17,OR S:.WP INSPEC, Y. UATE- <br /> FINAL LVSPEi-IT,> BY. -_ ,mow �•y `f �ry/��� r �yy ���;�i�r� <br /> PEJODF cc AMOUNT CIl[C.K ri RLCE mm DATE PEXMR7SERVICE REQL'ETF P SEPTIC[DO <br /> 7� [NFO ft.—TTM CAST{ <br /> �V V <br /> �kbbW-6 <br />