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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PU)3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3R°FLOOR;STOCKTON,CA 95202(209)469-3420 <br /> r NON-REFUNDABLE PERMIT EXPIRES I YEAR FROW DATE ISSUED <br /> JOB ADDRESS I 36-3 4, 404� APN0 �� � <br /> • // PARCEL SIZE: <br /> CITY/ZIP J r`-�U(i/��L7/L� os BUILDING PERMIT# <br /> /->0/3/3�i� � ��/ B✓--7- J ADDRESS 4 <br /> OWNER NAME _ <br /> CITY/ZIP � M/Y ��A, C a �/_._s ` PHONE NUMBER_ l{ :3 F/ <br /> CONTRACTOR ADDRESS ' "A <br /> ,CITY/ZIP PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE- SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: <br /> ///❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> SEPTIC TANK TYPE/MM Ii'�L ( �Q s�-C CAPACITY /Zv V " OF COMPARTMENTS <br /> (❑` GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST':. WELL FOUNDATION '.7 PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINE #OF LINES: � LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION 1 v PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPER'TYLINE <br /> ❑ MOUNDRD WIDTH LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE /I <br /> DEPTH � � DISTANCE TO NEAREST: WELL v <br /> SEEPAGE PITS # DIAMETER FOUNDATION PROPERTY LINE <br /> I 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 /> y t MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)468-3423 <br /> SIGNED: p <br /> TITLE: DATE: <br /> c <br /> ........Y_.•...........:............4....... ._�.. <br /> ...._ — <br /> ��..... ..... .. <br /> ...........'......................._............................. . <br /> ..<........................`......................._........ <br /> . ........ <br /> ' <br /> ... <br /> ... <br /> ......_:...............................i..... 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