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LIQUID WASTE PERMIT <br /> Fri <br /> C'�'?AQUIN COUNTY PUALIC HEALTH SERVICES ENVIRONMENTAL HEALTH DI <br /> ih f+ 394 E.WEBER AVE 3"FLOOR,STOCKTON,CA 95202(209)46M-3420 <br /> yp Q �/� /f NON-REFUNDABLE PERMIT EXPIRES 1 YEARFROM <br /> 1D�A'{TE ISSUED <br /> y JO8 ADDRESS��/�+! v '"c[-r7// AyN �J{J "�+UJ D-7 PARCEL SIZE: • "5 is <br /> i 14ek,�3t <br /> � BIIILDINC PERMIT M <br /> ! a.;0 , ER NAMC 0 - 7- �e�ta n� bee Tilt ADDRESS <br /> CITYI7JP S PHONE NUMBER <br /> C ) CONTRACTOR C ADDRESS <br /> I CITYIZIP PHONE NUMBER <br /> ' GEOGRAPHICAL INFORMATION: COORDINATES:X <br /> -Y-TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: IINSTA,L,LATION WILL SERVE: NUMBER OF LIVING UNITS: . <br /> ❑ NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: <br /> N ZPIREPAIRIADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER _ NUMBEROFEMPLOYEES: <br /> ❑ ENG INEEREDIALTERNATIVE <br /> .CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH; <br /> ❑ PERCTEST(S) HOW MANY APPLICATION# <br /> ❑ 'SEPTIC TANK TYPEIMFG CAPACITY #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> LI PKOTK PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE 0 OF LINES: LENGTH OF LINES:' - - <br /> DLSI'ANCETONRIREAT: WELL FOUNDATION PROPERTY LINE. <br /> FiINFLITRATOR CHAMBERS: <br /> ❑ PILTERBED WIDTH LENGTH DEPTH DATANCETGMARE. : WELL FOUNDATION PROPERTY LINE <br /> 1 + ❑fIL MOUNDED WIDTH LENGTH DEPTH msrANCETDNEARM: WELL FOUNDATION PROPERTY LINE SUMPR WIDTH LENGTH DEPTH DKTANCETO REARM! wE44 FOONDATON PROPERTY LINE <br /> 1# ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DmANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑- SEEPACEPITS # DIAMETER DEPTH DISTANCETON6ARLNTWELL FOUNDATION PROPERTY LINE <br /> 1 <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE BONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 - <br /> SIGNED: <br /> A � TITLE: O WNer DATE:Yn2 <br /> D,Q� <br /> t I <br /> 1 <br /> k 11� — <br /> 2-04%2- <br /> � <br /> I — <br /> BIC GALFV t <br /> 9 <br /> Fill <br /> Ad <br /> E <br /> /,fy^'�/I DEPARTMENT USE ON LY <br /> M +.(� /'1 <br /> APPLICATION ACCEPTED BY: X7./UThI�'UV OTE: °'Z-O'A�pREA�• EMPLOYEE IDp /�IJ pISIAlCf LOCAT30YQ C1 <br /> INSPECTED BY ➢ATE: PERMIT FIN AL7YESDAT. eGIN$FECTOR: <br /> MMENTS: l- wells }] Qi/ Inhck, <br /> 11 1 <br /> I <br /> PE CODE SC INFO AMOUNT CNECKMICASH RECEIVED DATE PERMIT1SERVICE REOUFSTf lNVOICEM SEPTIC IDM <br /> REMITTED BY <br /> 4-L 10 115- 18t sA0031278 <br /> REVrsED R-H-OI <br />