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i ( LIQUID WASTE PERMY �+a� y''�� i SA,__.jAQUiN COUNTY PU33LIC HEALTH SERVICES ENVIRONMENT,. ..EALTH DLVISION �s� ��i 304 E,WEBER AVE 3""FLOOR,STOCKTON,CA 95202(209)469-3420 °+-- -h �- �1 ' y n {�(�NON-REFUND BI,E PERMIT EXPIRES S YEAR FROM DATE ISSUED J) `x JOB ADDRESS ao 5 � +�0� APN M �+ PARCEL SIZE: 1�' E� SFV\ ,C�-tA—o� BUILDING PERMIT bCITY7P OWNERNAME coi�1 . Hoi&Q-Seclaip• ADDRESS 2bo-,/ J 1 CITYIZIP_ t� [ �� - .__ PHONE NUMBER L �1 ^Q [ / CONTRACTOR �TY Q, AS�(�J'jn2 ADDRESS aZ l' )'l) ' CITY/ZIPV1 L PHONE NUMBER cqo� 167- 376 / GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION TYPE OF S6;PTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNI'T'S: ❑ NEW INSTALLATION 13 RESIDENCE NUMBER 01,BEDROOMS: i ❑ REPAIR/ADIXTION ID COMMERCIAL I ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: ❑ ENGINE;FREDIALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER. WATER TABLE DEPTIL PERC TEST(S) HOW MANY APPLICATION# ��! v ❑ SEPTIC TANK TYPEiMFG CAPACITY #OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY #OF COMPARTMENTS fff ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM)' ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCETONEARLW'. WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: ❑ FILTER BED WIDTH LENOTI4 DEPTH DISTANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE N F ❑ WIDTH LENGTH DEPTH DIWANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE O MOUNDED ❑ SUMPS WIDTH LENGTH DEPTH 1)ISTAWFTONEAAF-W: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 1 ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE 70 NEAREST: WELL FOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEA%E CALL(209)468-3423 - C--^ 00 SIGNED:"-). TITLE:�1fUiC"�CIIS� DATE: / �o Z �v n � i r � i t r I 1 _...,._L. I„ ....... _,_,.,y. k'��•': aRwe NAY ; .....� ........... ............... l l#1 .. .._ E. ... ,. ...... . ' �.. i � E I I I ..__.., i ................................. 3 i ..........e !,. I i i we WAY j I __ _ _ L.......,..,'._.,...._�..._._._I - Nl•r' _ µ. rs-N }tel 1 y P15E 4.:4��EPt �� pN1�lOt ENVIRG....;�.... -. I ...., ......... ...... ....................................... .. 1 y/ DE PA R'I'M ENT USE ON LY ry AP CAT AC : TED DATE: ` ✓AREA Eh}PLOYEE IDb ✓ _r DIS LOCATION \ (rj�ji INSPE� �_D BV� 1�M '�'`l3r 'ATL: '=� PERMIT FINAL O]1+ES DATE: / G 1 CFOR;��c /1✓-��-,�. 'Iff-At1 L 1 COMMENTS:i rY') c�•7� /� C� �.�Y .lC� 1 " PE CODE SC INFO AMOUNT CHECK ASH RECEIVED DATE PERMITISERVICE REQUESTO INVOICEN SEPTIC IDN REMITTED BY SR 00291 5 RF:VISF:p x-15-0I