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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> / <br /> 304L WEBER AVE 3"'FLOOR,STOCKTON•CA 95202(209)468-3420 <br /> 2,2-190 <br /> ''') 2-1 !u 0 MIN-REFI-tiDARLE PERMIT EKPIRES F 1'F:,YR IR()Nf D.AT'F.Isst ED <br /> JOB AUDRE55� /T/U :.rQ.l G N!) APSN 2 PARCEL SIZE:—j�� 1,2— <br /> C1TVIZIP ,. LI '7 <br /> - BCfILDINC,PERMIT N <br /> OWNER NAME <br /> CITY/ZIP / f,'/- �A • �"l <br /> PHONE NUMBER <br /> CONTRACTOR F--L---t�Li/�J�C� [ .L ADDRESS <br /> CITVIZ.IP -r / <br /> PHONE NUMBER 1 �/ <br /> GEOGRAPHICAL INFORMATION. COORDINATES: X Y _ _ TOWNSHIP _RANGE SECIFON l�N <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: l <br /> ❑ NEW INSTALLATION ❑ RE-SIDENCEi —�` <br /> NUMBER OF BEDROOMS: <br /> U REPAI[LiADDiTIOIV ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEER FD'ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY APPLICATION# 7 <br /> ❑ SEPTIC TANK TYPE.'Mi'G_ CAPACITY i#OF COMPARTMENTS <br /> c� `+ <br /> ❑ GREASE TRAP TYPE/MFG <br /> CAPACITY #OF COMPARTMENTS t(`� <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE `•� <br /> ❑ LIFT STATION SIZE- rvrEOF P;IMP _ SAND OIL SEPARATOR(ENCLOSED SYSTEM)____ <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE.TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1NFLITRATOR CHAMBERS: �L <br /> ❑ FILTERBED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE f� <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL - FOUNDATION PROPERTY LfNE <br /> ❑ SUMPS WIDTH LENGTH DFPTH DIS"PANCE TO NEAREST: WELL FOUNDATION PROPERTY LING <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL. FOUNDATION PROPERTY LINE <br /> LJSEEPAGE PITS # DIAMETER DEPTH DISTANCE TONEARFST: WELL FOUNDATION PROPERTYL.INL <br /> I HEREBY CERTIFY THAT]HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> .AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> l IR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)455-3423 <br /> i <br /> SIGNED: Q <br /> TITLE: <br /> y/L'G 1/V> _.tr /L� DATE: <br /> i <br /> s� 33 <br /> Sl TE ....... rC� IP ....... <br /> `. ._ SAK Ei <br /> � <br /> 7yy� I DF,PAR7MFNT IN ONIY <br /> APPLICALYON ACC'EPTEO f( I` �L DATE, _ ' //j �j� )2F.A_2�MPLOY EL IDI R DLST <br /> /��(,-,�fl V-/ RIC�LOCATION J <br /> Zt <br /> INSPECTED BY: -- DATE- - I' PE/RMIT FINAL 41 YES DATE: fiVSPECTOR: <br /> COMMENTS: 0& <br /> �C ' fie-�'-., Q._RO. �`'k t'<.-'- �'e' c <br /> �s <br /> PE(:OID)L $('INFO AMOUNT CHLCK#iL'ASH RECFIVED DATE F.RMIT'SERVICE REOL:EST# INVOICE.# SEPTIC TD# -n <br /> REMITTED BY <br /> RE VFSED"-"l `' <br />