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LIQUID WAS PERMIT <br /> !rl, v SAN JO-QUIN COUNTY PUALIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> `l{J 3114 E-Ill..AVE 3"FLOOR,STOCKTON,CA 95202(2M)46N-3420 <br /> A NON-REFUNDABLE PERMIT EXPIRES I YEAR FROMDATE ISSUED <br /> JOB ADDRESS) 7-ltlG .Q APN 0 <br /> 5I95nnq PARCEL SIZE: <br /> f CITVfZIP BUILDING PERMIT 4 <br /> f �nl�f 11 <br /> OWNER NAME GCf ADDRESS�2l V W• JGT4'PYd�hDy <br /> 2 I <br /> CITVIZIP Lo <br /> �(A '7o J -_ _- PHONE NUMBER <br /> CONTRACTORS�s://'.N� zl� ��:G'�1G - ADDRESS 1 <br /> E 1 CITYfZIP ::� - ' PHONE NUMBER <br /> -ter GEOGRAPHICAL INFORMATION: COORDINATESX Y, TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ <br /> ❑ NEW INSTALLATION It RESIDENCE - NUMBER OF BEDROOMS: ._- <br /> bt-REPAIR/ADDITION ❑ COMMERCIAL - <br /> NllMBEROFEMPLOVEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> } ❑ ENGINEEREDIALTERNATfVE <br /> I ) CHARACTER OF SOIL TO DEPTH OF 3': GI✓wj PITISUMP SOIL CHARACTER: 4e/P ��Zsc�� - WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY - APPLICATION N <br /> ❑ SEPTIC'TANK TYPEIMFG F,ti5fiwc. CAPACITY #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY #OF COMPARTMENTS <br /> Cl PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION.' PROPERTY LINE- <br /> 13 <br /> INE <br /> 1133 LI <br /> LIFI'STATION SIZE TrPEOF POMP ���� - m. -TO SAND OILSEPARATO�R(ENCLOSED SYSTEM) V <br /> IP- LEACH LINE #OF PINES' LENGTH OF NES: �![U f uANCENEAREST: WELL yrON <br /> V,4' FOLNDAT �` PROPERTY LINE <br /> INFLITRATORCHAMBERS: —� <br /> ILr ❑ FILTER BED WIDTH _ LENGTH DEPTH DrnANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> L - ❑ MOUNDED WIDTH. LENGTH DEPTH o[STANCETO NEARER: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEARECE: WELL FOUNDATION PROPERTY LINE <br /> r 1 ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TONEAREST:' WELL - FOUNDATION PROPERTY LINE C <br /> I <br /> SEEPAGE PITS #—�,---,_ DIAMETERL_yg DEPTH , O15TANCE TONEARERT: WELLf>G/ FOUNDATION�O PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE 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 <br /> �CALL{299)468-3423 <br /> L SIGNED: I TITLE: -DATE: G e� <br /> — <br /> _rv_ <br /> i � I <br /> �i <br /> T•j--. i� � - - - <br /> ._. <br /> nilp , oI <br /> TE� <br /> I _ <br /> r 111 <br /> i <br /> � DEPARTM ENC US-ON,Y � <br /> 1' y. APPLICATION ACCEPTED BW - / .ATE:_ ARFA MPLOYYEE IDH C)- ISTRI�.CATION 1 <br /> INSPELTEnB �� DAT/ ��' PERMIT FIN YES DATE: `�A NSP£CPDR: <br /> 'COMMENTS <br /> PE CODE SCINPO AMGDNT CIIEC lC.ASH RECEIVED .DATE _ PERM T/SERVICE R EQl IN LIVpICEn SEPTi('I— <br /> REMITTED BY <br /> Z o S I if aoo a <br />