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I LIQUID WASTE PE h'Ng < <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH D]VI IN / <br /> 304 E,WEB£R AVEC FLOOR,STOCKTON.CA 95202[209)46R-3420 !_�m/-g <br /> J�J' [ .�€, y�,,,-��'NO,N-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED p" ''�'�1'ql�(!f /� L� <br /> JOB ADDRFSS I " ' w APN ' ._. PARCEL SIZE: <br /> F CITYIZIP /C,L' c7-S-23 J_ HU]LUINC PERMITP <br /> ` OWNER NAME Al 1Xf ADDRESS <br /> f CITYIZIP — PHONE NUMBERp- <br /> -� CONTRACTOR as ',j4 iCL -7 ADDRESS `•] I�a <br /> CITYIZIP ,\ r PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION; COORDINATES. X Y. TOWNSHIP RANGE SECTION - ' <br /> Fes+ TYPE OF SEPTIC WORK: [N TALLAT.ION WILL SERVE: NUMBER OF LIVING UNITS: <br /> l ❑ NEW INSTALLATION p RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIWADDITSON O COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEEREDIALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': SBh/__ PITISUMPSOILCHARACTER; WATER TABLE DEPTH;_Zp - <br /> ff ❑ PERC-FEST(S) HOW MANY APPLICATION# <br /> Ja SEP'TICTANK TYPFJMFG_ G i�C CAPACITY /2 O!3 #OFCOMPARTMENTS� <br /> ❑ GREASETRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT 'DISTANCE TO NEAREST: WELL . FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOF PUMP_ SAND OIL SEPARATOR(ENCLOSE])SYSTEM} (`p <br /> ff 41 #OF LINES: LENGTH OF LINES: V' <br /> Y i ❑ LEACH LINEDISTANCE TO N€ARLAT: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> S <br /> i <br /> ❑ FILTER BED WIDTH- LENGTH 3s_ OEPTH DI."TANCETONEA-€ WELLj:n? FOUNDATION AT PROPERTY LINE r �S 1 <br /> 1 ❑ MOUNDED wIDTR LENGTH DEPTH DLRANCETONFARE : WELL FOUNDATION PROPERTY LINE q <br /> ❑ SUMPS WIDTH LENGTH DEPTH DI.4TANCFTONI.R&NT: WELL FOUNDATION PROPERTY LINE l <br /> IC�•`J� ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH GMANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 ❑ SEEPAGE PITS # DIAMETER DEPTH D14ANCE TO NEARLW; WELL F0UNDA710N PROPERTY LINE ' <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS <br /> �e t AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY- - <br /> L MINI M 4 R ADV E NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)468-3413 <br /> �-- SIGNED: �— TITLE: DATE: , <br /> T�I'U IQ <br /> �_ <br /> 7F F <br /> � <br /> I I } 11 ...... <br /> _ <br /> I <br /> ve <br /> Fj <br /> I�.. <br /> 1 <br /> DEPARTMENT IJ59 ONLY <br /> I APPLICATION 11 BY _DATE'.-_� AREA-?�(1EM11O1 EE Dft ISTRI LOCATION <br /> INSPECTED DATE: PERMII7 FIN ES DATE. //�2��MIIECTO C - <br /> [ { <br /> COMMEN7S: `�`� I L <br /> + € <br /> PEC E SCINFO AMOUNT .HECKMIC H RECEIVED ATE PERMITJSERVICE REQUEST# INVDICE# SEPTIC IDM <br /> REMITTED BY <br />