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' 7-0-7050-11- Got ' <br /> LIQUID WASTE PERMIT , <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 57 90r^1✓X0j-,-> <br /> 304 E.WEBER AVE..3"0 FLOOR,STOCK'I'ON,CA 95202 (209)468-3420 <br /> 1 <br /> NON-REFUNDABLE PEP-NUT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS { S � 1 +� 1 y� - <br /> CI'IYfLIP ,►�+�^ ct i E PARCEL SIMAPN 1 ,J- `�+os q�� <br /> OWNER NAME 1Y wlr] h 1T�1✓lE . j,�C• ADDRESS <br /> CITYIZIP ` PHONE R� <br /> CONTRACTOR 1C lc�� 10�E�1�•����-• ADDRESS f•f"bZS �•C' `'�a i i 1 <br /> CITYf7.IP f ^-^ 9-c; PHONE. — <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIPRANGE_SECTION <br /> PERC TEST(S) A HOW MANY Z. APPLICATION d: _ <br /> TYPE OF SEPI IC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE. ❑COMMERICIAL ❑OT•HER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES <br /> CHARACTER OF SOIL TO A DEPTII OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANKOGREASETRAP TYPFIMFG CAPACITY NUMBEROFCOMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELD FOI INDATION__•. PROPERTY LINE <br /> ❑LIFT STATION SIZE 'IYPL•OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES J INFILTRATOR CIIAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION _ PROPERTY LINE <br /> O FILTER BED WIDTH LENGTH DEPTH _ <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LINE PAYMEN � <br /> -RECE11/EC;• <br /> ❑MOUNDED WIDTH LENG'111 DL•l'Tll <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPER'T'Y LINE.. 3-0 <br /> 3-0 <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH lkl <br /> SAN dOAQUnV COUNTY <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LIN I3'I IBI tf`u ti'i SEP mCE$ <br /> ENORONMEN- <br /> ❑Sumps WIDTH DFPI'H __•.•_,,. `- <br /> DISTANCE T'O NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DrimI <br /> DISTANCE TO NEARFST: WELL FOUNDATION PROPERTY LINE ` <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATIlLAWS,AND RUL NILREGULATIONS OF SAN JOAQUIN COUNTY. //^^ r <br /> SIGNED: TITLE: rl DATE: Z 1 <br /> G <br /> ' yI—...r rr.r ��.•'r•r. .. <br /> •. i...__.. --1—�-rte-- ------_.._� T—~ <br /> r rs raew I I I I 1 9i ••: <br /> 1 <br /> _L _ = _._. -- - � ---. ---- <br /> PROP O S E U B I T E PLA 1: <br /> FOR DEPAR 1B.NT USE ONLY / <br /> APPLICATION ACCEPTED BY DATE v <br /> TANK.PIT,OR SUMP INSTFf_TF RV. <br /> FINAL INSPECITON BY: <br /> CUMMt1dIN: <br /> PE CODE SC AMOUR-T 'K RE'CED'ED BY i)A1'F. . . .. T f SEPTIC IDo <br /> IN RRMITTED <br /> b <br />