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LIQUID WASTE PERl1' <br /> L-.N JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENV IRO E LTH V <br /> 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 9 )46 3420 <br /> MIT EXPIRES I YEAR 0 SU <br /> �y /�}�/� t�'J� <br /> NON-REFUNDABLE PERMIT _ f� <br /> JOB ADDRESS OL 3 Z 3 3 , "- ,��� APN �6 J��`tea / ! PARCEL SIZE: <br /> r � <br /> CITYIZIP �'Q�e- -,J CP � 1al �2 � BUILDING PERMIT#OWNER NAME / ` v a ADDRESS -:23 233 �i Dos ,f <br /> CITVIZIP_, �C I '1 ! '!SZ'X_ = PHONE NUMBBEER +� /j ar-✓� <br /> �! ADDRESS- J J S C' <br /> CONTRACTOR <br /> CITYIZIP C.> PHONE NUMBER­A"J-9-3� f"�7 <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> 1 <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE; NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ,RESIDENCE 'NUMBER OF BEDROOMS: <br /> ❑ REPAIRIADDITION 0 COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> I ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER:'• WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY APPLICATION N l <br /> ❑ SEPTIC TANK ' TYPEIMFG CAPACITY #OF COMPARTMENTS pw� <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY #OFCOMPARTMENTS W <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> { ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TONFARE3T: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DIS-I'ANCETONEARE-VT': WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL - FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DIRTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI HOU DVANC�E REQUIRED FOR INSPECTIONS-PI EA4,E CALL(209)468-3423 y /, <br /> SIGNED: TITLE: (L/1 L`f1.�Cr� DATE: <br /> �—�- <br /> ..I r. 3 .a <br /> .._.. ...,....J ..,..,I. .�,., 1 .... 4Y 10� 1...A� • i... <br /> I <br /> 4 : <br /> I <br /> k <br /> ` r ! co <br /> 4 s v ...I r <br /> I <br /> ...........E - _. ' _ I . - J {€ I1a \! i Y IIS-.4 J 4 <br /> 4. <br /> I I. <br /> f i <br /> i <br /> I <br /> 1 <br /> ` I.. ...1.... .. _ ___.�. 7_.. ...."..,..,. <br /> 1 :..,,.. N ROf�JIMENTAL . .. ............ ', <br /> y EiTAf M <br /> I� <br /> I EEA TI 1 DIEPART <br /> ...,...: ....... ..... ....... <br /> [[ I <br /> r' -.« <br /> r�ctY`•R �`"�"--Tr <br /> 3 <br /> DEPARTMEN <br /> T ] <br /> APPLICATION ACCEPTE Y'.V _DATE: AREA EMPLOYEEID#_ DISTRICT LOCAT]ON <br /> � - � i t <br /> A y 3 .y/� <br /> INPEF'FED BY: /•i! & ii, DATE: f--7 '"1� PERMIT FINAL 0 YES DATE: INSPECTOR: <br /> 3 - p Awl <br /> o^W64 At <br /> �i /gyp y� <br /> 41411 <br /> 6%J#j ,i- x'65-- ,',R•%S 4t, � i `,7 •a - '"7 i - /'(°�c•l.c r-.:.-Gv�1"/�� <br /> rl <br /> _ r �. <br /> tc <br /> I PE CODE SC INFO AMOUNT CHECKM/ SH RECEIVED DATE. PERMITISERVICE REQUEST# INVOICE# SEPTIC ID# <br /> i REMITTED 9Y <br /> gra. : a�2 2� ootIl4�z <br /> o <br /> I <br /> REV 1'SED X-45-0[ ' <br />