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3� LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(209)468-3420 {7 NON-REFUNDABLE PERMIT EXPIRESfI YEAR FROM DATE ISSUED JOB ADDRESS 114 .�er�QIP�1 /� APN `dI,- 12-0- dZ PARCEL SIZE:--l-Ey . 7f CITYIZIP_ x�(/�{ T`` 4a BUILDING PERMIT 9 J OWNFRNAME_ "�Ofl A+Lyry/'FL p�.Q ¢.n _ ADDRESS 3fpo-� C7�!'o-yV� � c71r4U�. CITYIZIP J'1lOy� l sj' PHONE NUMBER 610 4-7 I - o-36* CONTRACTOR NIEIL_ n_ AnAQr-kon $_ - ADDRESS '2,2 V-e CITY/ZIP . - tod: i =L ?-!to _ PHONE. NUMBER S r '? - 3-10� GEOGRAPHICAL INFORMATION: COORDINATES: x _ Y TOWNSHIP RANGE. SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: ❑ NEW INSTALLATION ❑ RESIDENCE NUM BER OF BEDROOMS: ❑ REPAIR/ADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES:L3DESTRUCTION ❑ OTHER ❑ ENGINEERED"ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3% PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: FERC TEST(S) HOW MANYAPPLICATION ii FA-O ❑ SEPTIC TANK TYPEMFG CAPACITY 4 OF COMPARTMENTS ❑ GREASE TRAP TYPE;MFG_ CAPACITY #OF COMPARTMENTS {h ❑ PKGTX PLANT DISTANCE TO NEAREST: WELLJ1 FOUNDATION PROPERTY LINE ❑ LIFT STATION SIZE_ TYPF OT PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINE P OF LINES' LENGTH OF LINES: DISTANCETONEARESTc WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: a I ❑ FILTER BED WIDTH LENGTH DEPTH_ DISTANCE TONEARE.W7 WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH,_ DISTANCE TO NEAREST: WELL FOUNDArION PROPERTY LINE � ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETDNEARESTp WELL FOUNDATION PROPERTY LINE VSs. ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SEEPAGE PITS DIAMETER DEPTH DC:-TAACETONEARESTv WELL FOUNDATION PROPERTY LINE �--I — Q 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS 4 AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR LNSPECTIONS-PLEASE CALL(2041168-3423 7j SIGNED; l/�+!'. N . O. ATL n�TITLE: to r_ DATE: 2 % Q : v If 260* _ .. . 10 -- _ 5000000000c: - .,. 11 O D O O D O O O 0 r C)o 0 0 0 0 0 0 c c 00 0 0 0 0 00000 y - 000 00001130 U 541 00000000000 T' - O O O O O O O O p 0 0 0 0 0 0 0 0 0 0 ..: --`---..,.. .1 ..,.- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 �...._.-...,._T-,.._.F.... -: 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ".'." ... -'.. - y --- 000000000 Hw �m 0000000000 -� --'.,-. _....... ......, 000000000 �� Ao 0000000000 ' 0 0 0 0 0 0 0 0 0 4°x "'-� - ---'--- --- 0 0 000 00 0 0 Ax s17RA000000 _ - - i 400000l b�• �", S 4000000000 rri --- CCC...r 0000000000 - # - O O g O O O O O O ZP— --- 00000 000000004 • + ;.... a 0 0 0 0 0 0 0 0 4 0 000000000 _I )w .0 0 0 0 0 0 0 0 0 I 0 0 0 0 0 0 0 0 0 0 .S 00 0000 DOO ' 00 000 00004 Tr{ Z-S j� .,. --., 0 0 0 0 0 O O O O O I -.-.- Ii----....-- -7 ....-- .,.... U Ilk- - --'-" 000000000 000000 t 00 0 00 0 000 'a 000000Cc)cc 000 QW PEA7YLIOO a 0 00 �U- ;ate! gIy' 000 4 a 0 0 4 0 0 o O o 0 O - 00 y:6. a000-- I ' I - jr . - 000000040 .oo 0 00 -. nr - e : DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. V'`-"� � � 4ATE: 'I �"AREA A-i EMPLOYEE IDO �3 7 4 DISTRI _ LOCATION qlINSPECTED BYDATE: [! PERMIT FINALES DATE L INSPECTOR: }� ` COMMEN"rS,_It_wa—� - 1V[ l� -_-VV� •C-l'�� /I ��L�{� 1l i 4F CSiDE 5L INFO AMOUNT CHECR*! SII RECEIVED DAI"E PF.RMITSERVICE REQUESTo INVOICE* SEPTIC IDA' REMITTED BY - �+,-ZzzS900 0 2 I REVISED&I"I