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III LIQUID Wf ` <br /> Q AS'I, ERMiT <br /> F SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES tNV IRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3Y°FLOOR.STOCKTON.CA 95262520914614-3420 <br /> �y n NONEFlill�)ABL�IE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> f JOB ADDRESS-_�F L�{� Cr C.<✓Y7,/'oPp+��ci--�%II /}t! APN�L7 ! 3 'x15 PARCEL SIZE: G <br /> CITY,'ZIP -7th-a�� i cA BUILDING PERMIT* <br /> 7 OWNERNAME ADDRESS <br /> CITVIZIP c,3 G PHONE NUMBER <br /> CONTRACTOR__ L�7 7� GC�•l-Cl ADDRESS ! ^'6!N" _ ts-a <br /> CITYIZIP PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES, X Y TOWNSHIP RANGE SECTION <br /> - TYPE OF SEPTIC WORK: INST LLATION WILL SERVE: NUMBER OF LIVING UNITS:_�_ <br /> VNEW INSTALLATION 7SIDFNCE NUMBEROF BEDROOMS: 3 <br /> -- Cl REPAIRJADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> CI DESTRUCTION ❑ OTHER <br /> ❑ ENGINEEREDIALTERNAT[VE <br /> CHARACTER OF SOIL TO DEPTH OF 3':_j (V,yam PITINUMP SOIL CHARACTER: S CACI. WATER TABLE DEPTH: <br /> ❑ PERCTEST(SI HOW MANY APPLICATION �1 <br /> .� SEPTIC TANK TYPEJMFG- ��t.. CAPACITY 0 OF COMPARTMENTS eC <br /> J5 ❑ GREASETRAP TYPFIMFG CAPACITY NOFCOMPARTMENTS <br /> 7 1 <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL l_DL FOUNDATION PROPERTY PROPERTY LINE 16�* <br /> ❑�LI FT STATION SIZE TYPEOFFUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �- LEACH LINE F OF LINES: LENGTH OF LINES: N,11l oII.TANCE m neAaen: WELL' FOUuoaTlpx 0,, PROPERTv <br /> INFLITRATORCHAMBERS: <br /> I <br /> Fl. <br /> ❑ FILTER BED WIDTH LENOiH DEPTH DBTANCETPNEARLc: WELL FOUNDATION PROPERTY LINE <br /> 1i F ❑ MOUNDED WIDTH LENGTH DEPTH DI ANCETONEAa6tt: WELL FOUNDATION PROPERTY UNE <br /> ❑ SUMPS WIDI LENGTH DEPTH DFSTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑_, DISPOSAL PONDS WIDTH LENGTH �JJ DEPTH DESTANCETONEAREST: WELL FOUNDATION +� PROPERTY LINE 9 <br /> 4T SEEPAG£PITS IF '2* DIAMETER .'J[r�l DEPTH- DCSTANCf TO NEAREST: WELL FDZ <br /> OUN <br /> ATION 0' PROPERTY LINE—LQs2-1r <br /> 777 F <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 C <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM M24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20%)468-3423 p� <br /> SIGNED: LTITLE: Codr1# --- -a!- DATE: p IS d.3 <br /> I W <br /> Lv <br /> -- <br /> F I.. <br /> _ t <br /> ' i <br /> n slir, no IN <br /> AN Ian -- <br /> TuBdIGHILAL 5 ktil�t rs. <br /> fj <br /> r4t <br /> DEPARTMENT USE ONLYG-.{-APPLICATION AOCEP DBY: S/ 1+' DATE!_ AREA 8'EMPLO1EE IWQ ISTR • LOCATION <br /> —11 <br /> INSPECTED OATS --t� PERMIT FINOL.�I YES OAT���2> <br /> *ri — <br /> j { COMMENTS: <br /> j[ III PE CODE SC INFO AMOUNT ASH RECEIVED DATE PERMITISERVICE REOUEST01 INVCICE4 SEPTICID0 <br /> REMITTED BY <br /> Fjati 11;17-- J 30F(,9 <br /> REVISED Y.IS-DI <br />