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.y <br /> LIQUID WASTE PERM F � �3 <br /> wp <br /> TJOAQUIN COUNTY PU,8L1C HEALTH SERVICES ENVIRONM HEALTH DIVISION <br /> r - 304 E.WEBER AVE 3"0 FLOOR,STOCKTON,CA 9526­­,468-3420 - - <br /> N(��1NU LE PERMIT EXPIRES �R FROM DATE ISSUED 1 <br /> JOB ADDRESS {�J�/ APN 1 li STI PARCEL SIZ 11 G <br /> ED <br /> CITYlZIP � -I/ / tthl��';BUIL/D/�I�N.�G PERMIT# <br /> i V <br /> OWNER NV AMEc:� -11XW � (//�� ADDRESS <br /> CITY/ZIP- - �C (GJn PHONE NUMBER " G� <br /> CONTRACTOR �i( J' ��' �� ADDRESS. ✓�. � <br /> CITY/ZIP-rc_/ G�/C/ (Q PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y- TOWNSHIP' RANGE SECTION <br /> f <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> C] NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ <br /> REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> C3 DESTRUCTION O OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY o )APPLICATION# <br /> ❑ SEPTIC TANK TYPE!MFG� CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS r` <br /> I ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE �- <br /> (yc <br /> ❑ LIFT STATION SIZE TYPE OF rUMr SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: - DISTANCE TO NEAREST: WELL FOUNDATION . PROPERTY.LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH _ LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION - PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DLSTANCETONEAREST: WELL FOUNDATION PROPERTY LINE P <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE.TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> ❑ DISPOSAL PONDS -WIDTH LENGTH -DEPTH DIll TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS _ # DIAMETER DEPTH DISTANCE TO NKARPST; WELL FOUNDATION PROPERTY LINE <br /> J <br /> I HEREBY CERTIFY THAT 1 HAV PREPARED THIS AP (CATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RU AND REGULATIONS OF SAN JOAQUIN COUNTY. - <br /> .0 <br /> INIMUM 2 E NOTICE REQUIRED FOR INSPECTIONS-PL WE CALL{204)4668-3423- / <br /> SIGNED: TITLE: ?f• y8-!34DATE: L �2— <br /> -I_. -r.......... I-.. <br /> I - i <br /> I <br /> . ... nom <br /> I i ... . <br /> I _... . <br /> 1 .------------ --- t <br /> I i <br /> € FW.12,�D@2 113:R3w STCrCI(TUN uFICCESFL _ I ! I t. <br /> I I NO, P.Z2 F <br /> 7. <br /> I . 1 <br /> gI I /Ir <br /> .tea,..,..,{ ..... <br /> 4 u Z <br /> �- '''� I -, t a c c ;tib w y w . W y,} a �' 2 `mss <br /> l j r�(1r e ti � � �b W r I _ ....r...,.-.. <br /> i I _�mh O �. • O �4 i 0 Z v h �O <br /> .. <br /> th <br /> 11 II �. �lea <br /> -"I. 1 f I "i:3' .-_.3•?�.-• �3,Z0 .0 Y7 F <br /> .-.,...- <br /> f 4 - . <br /> -- � ` <br /> 10 <br /> 1����yer �'MOAO�ai.9?VT- 577 So m �s.. _ P� Ll6' a11 _Gd�fVT I <br /> � �,.sa • ,}C31 Ali 5� 5 � <br /> r I I <br /> .--.....I ..a. a Nd VONE --!�Q� 191 <br /> f I �i- <br /> I, R041,N1tlsI,,, - + E f �„I, <br /> I � 1, I I r �,--;, 4­­+ � � J � ' � { � ”� I I i { � I .,�..-.-., <br /> ...,..,..,..,.� <br /> .. t r j.....l 7 <br /> �-�. <br /> �/►/y/� [//-//�[���(__3(`Y��, nEPARTl4t) T USE(?N Y <br /> APPLICATION ACCEPTED HY: -DAT[: (n� IM AREA LWP-LOYEEI DISTRICT 'LOCATION <br /> INSPECTED BY: /// 'DATE: R:-- PERMIT (NAL L] YES DATE: INSPECTOR: ' <br /> COMMENTS J aZ �GUfI` B 1 'p / ) •�Y�-. LuTS +� C �72 YL>` <br /> I : <br /> r ` <br /> PE CODE SC INFO AMOUNT I CHECK4 <br /> 1 ASH RECEIVED DATE PERM ITISERVSCE REQUEST# INVOICE# 'SEPTIC IDN <br /> REMITTED BY <br /> 2zz 5Z � � 11 � z � � ioo <br /> 3o � w <br /> REWSEDTI-I"I <br />