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LIQUID WASTE PERMI'. C' <br /> N , $ OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTACIR <br /> 1VI a 7- ��" G C <br /> �� Iv1 4230 .WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 (24 1�l�r2-Ini G <br /> \r ^ ��/�� N--RF, UNDABLE PERMIT EXPIRES 1 YEAR FROM DATED <br /> JOB ADDRESS �- yJ/'-f C-S 'U &I- �/ ` <br /> CITY/ZIP -1 ,.tP�P7 / PARCEL SIZEIAPN r O U 3 %�r"� o o <br /> OWNER NAME L��GGD Cr/J DSA "Wa ADDRESS �� /V Gt[/LQa/ i IJ ti— <br /> CITY/ZIP <br /> LCITY/ZIP���� / S Z l GI/ n PHONE tog, <br /> CONTRACTOR ADDRESS <br /> �f ' Z 5- <br /> CITY/ZIP _57- 7"` <br /> �r� sl j 7� PHONE / a _ 13: '415— <br /> GEOGRAPHICAL <br /> 415_GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP RANG� SECTION <br /> PERC TEST(S) HOW MANY APPLICATION#:_ l✓ <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION T <br /> PAYM,VED <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL 13 OTHER p <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: R <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABL�DEPTB O <br /> ❑SEPTIC TANKIGREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS tt COUNTY <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE SA TN SERV(�ES <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ENVpub 10 Ni HEALTH DIVI ION <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> 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 PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFTFIAT I HAV R ARED T APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,ST LAWS S AND ATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: r TITLE:/ /�T P�'��/N1E: a/ D0 <br /> 1 TENTATIVE PARCEL MAP TEN7N�,,TATIVtMAP <br /> 4I,x.A.iL., APOlication# M -00' 4- {at- <br /> Received By lAI On <br /> .'x•�iLw�'i 7 <br /> cow olw s[xx.Au. DµAL S , <br /> [[� fFL l •�+ •� <br /> i•3 <br /> NOTES .w—ca•,ww.x[ i[c.f <br /> iI I KSIGNAIE REMAINDER y su.l� <br /> L <br /> mo uis:Ac. <br /> Z. <br /> IF H � ,rII LLaLnnulr lb <br /> PARCEL I <br /> 1.79 At. <br /> t >[f• r <br /> R+uK+IOM � }0'Llr <br /> Lrz 1, uw[e.x. <br /> 1 <br /> " W <br /> V <br /> r[[+xL M1D. ,ar V <br /> f <br /> VICINITY MAP P I 1 t� I �G� <br /> FOR D?PAR7'ME '1 :E ONLY <br /> APPLICATION ACCEPTED BY: <br /> DATE: (_ <br /> TANK,PIT,OR SUMP INSPECTED BY: <br /> DATE: <br /> t <br /> FINAL INSPECTION BY:_ -- <br /> COMMENTS: <br /> PE CODE SC AMOUNT CHECK# RECEIVED BY DATE PERMIT/SERVICE REQUEST# SEPTIC ID# <br /> INFO REMITTED <br />