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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> S 304 E.WEBER AVE,3%O FLOOR,STOCKTON.CA 95202 (209)468-3420 SE RTIC. <br /> NON.RFiyUNDARI F PERMIT EXPIRES I YEAR FROM DATE ISSIIF.D <br /> JOB ADDRESS ! ��53---M'"CrtU Rv <br /> CITY2IP <br /> �('� jA �"`yti p PARCEL SIZE//AP It, <br /> -. y� P4,-.-s ' <br /> OWNER NAME Ob son.1 ADDRESS <br /> CITY/m PHONE <br /> CONTRACTOR / I/1 FGA T'Z.�!�- p ADDRESS <br /> CITYIZIP CR+-eb' G1 L S 3 3& PHONF,�, rt•�q�Tt 3 <br /> GEOGRAPHICAL INFORMATION:COORDLANTFS: X Y TOWNSHIP__RANGE_SECTION <br /> PERCTEST(S)( )HOW MANY APPLICATION <br /> TYPE OFSEPTIC WORK: _❑//NEW INSTALLATION W'REPAIR/ADDIfIO`J C3 DESTRUCTION <br /> INSTALLATION WILL SERVE: BRESIDENCE ❑COMMERICIAL 13 OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: -55-10W f-&V 4% PJT/SUMP SOIL CHARACTER: J ai'+d WATER TABLE DEPTH <br /> ❑SEPTIC TANIUGREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS — <br /> ❑PKGTREATMENTPLANT DISTANCE TO NEAREST: WELL _. FOUNDATION_._— PROPE.RTYLINE <br /> 13 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 111 LEACHING LINE NUMBER&.LENGTH OF LINES 4 FtO/ INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST. WELL FOUNDATIONI A,�PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST:WELL_-......._ FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 13 SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLINE <br /> I I <br /> SUMPS WIDTH LENGTH 149 DEPTH, — <br /> DISTANCE TO NEAREST: WELL 1 ODI FOUNDATION rO T PROPERTY LINE ZO1 <br /> ❑DISPOSAL PONDS WIDTIi LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL. FOUNDATION___—______PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCFS,STATE LAWS,AND JJULEJ AND REGULATIONS OF SAN JOAQUIN COUNTY. �^ <br /> SIGNED: 7Wf/IrJ _-_._._.._......._...._.._...__—TITLE:SLEp� f 4 '�r DATE: <br /> i <br /> I <br /> r <br /> II P <br /> 1 I � <br /> I _ <br /> FOR DEPARTM&hT USE ONL —'216G+�E <br /> LI DATE: <br /> APP.JCATION ACCEP ED BY: <br /> ATE <br /> TANK PIT,OR SUMP-5— <br /> FINAL. <br /> UMP-5PEFINAL INSPECTION BY: <br /> JOaQUIK C' as <br /> COMMENTS: Qub Nea,.Tt+ <br /> Mali <br /> PECODE SC AMOUt ECK RCCEIVFD BY DATE PFRN11TISERVICE REQUEST N SEPTIC IDe <br /> INFO R&M CA <br /> ZfO �il$3—a. <br /> I — <br /> I � <br />