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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PU.BLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)468-3420 <br /> S C 16' <br /> �t ADA/� <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Jo'-'IVa ADA APN l 03/a r 1 PARCEL SIZE: <br /> CITY/ZIP-,5 ikr'j BUILDING PER/MIT�#.�/ �( A /� <br /> OWNER NAME � G1r /`ibA <br /> L<1Y" <br /> y ✓' ADDRESS �U ISL <br /> CITY/ZIP //����-�-��Y ► G J e7 � PHONE NUMBER(C 1 ��, A <br /> CONTRACTOR Ti)`�u R.bl �� ADDRESS 3 y� ti C/[)lam "-A� A l/ <br /> CITY/ZIP (S't'i�I� PHONE NUMBER 0596--)6-0 20 <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION 11 RESIDENCE NUMBER OF BEDROOMS: <br /> REPAIR/ADDITION ❑ COMMERCIAL <br /> Ll DESTRUCTION Ll OTHER <br /> NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL j FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: J LENGTH OF LINES: lb DISTANCE TO NEAREST: WELL/uJ FOUNDATION PROPERTY LINE <br /> 411 <br /> INFLITRATOR CHAMBERS: c4-/M-r0`4& <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE A~ <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION _ PROPERTY LINE 1, <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION wry PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETERAlf_ DEPTH o1sTANCETorvEAaEST: WELL/ FOUNDATION Ttry PROPERTY LINE oLGJ <br /> 1 HEREBY CERTIFY THAT 1 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 /> MINIMUM 244 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)468-3423 0 <br /> SIGNED: C�j*B'[��O.S�e./ A!6'bn K,�b TITLE:&Mo& S!AA l DATE: 11­19-01z <br /> IV <br /> .. .. . <br /> i _ <br /> ........ <br /> ... <br /> ......_..s................_....._.»...........' .. .. ... .... ... ... ... ... -- .. ... ... <br /> ......€..........:.. <br /> ...._:..... <br /> .. <br /> i : ' <br /> ... <br /> ............_i.................._ . ... ... <br /> .......... <br /> .....................1..... ; .. .. <br /> ... <br /> (J .... <br /> ........:.. <br /> ... .... <br /> .. <br /> ...... .................. ,.. °:. <br /> ... �.. .. <br /> .: . ��.. ... .. t `� <br /> gfb '}et4V�J'� <br /> �..�� ' SA <br /> 31Z Orr N� <br /> F <br /> _ _ <br /> I <br /> DEPARTMENT U E O LY <br /> APPLICATION M <br /> BY: DATE: aL-AREA . EMPLOYEE ID#DISTRICT LOCATIONY <br /> INSPECTED DATE: PERMIT FINAL /YES DATE: I//��Jj/INSPECT <br /> COMMENTS: �C/ <br /> PE CODE SC INFO AMOUNT CHECK SH RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# SEPTIC ID# <br /> REMITTED BY <br /> -703 3 2� �� o : 0 3% 7 <br /> REVISED 8.1."1 <br />