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LIQUID WASTE PERM' <br /> -� �OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMB EALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202( 6R-3420 <br /> ,F !�y- �` NON-REFUNDABLE PERMIT EXPIRES i YEAR FROM DATE ISSUED <br /> JOB ADDRESSZ J.`rV Q EAS 7 <br /> t . Pn L, P].� APryo"ZSS- <26- U 13 PARCEL SIZE: -7.3 7Ar- <br /> CITY/ZIP YL1"F �jr ../4L7�Z'/� BUILDING PERMIR <br /> MIT }� (+ <br /> OWNERNAME 4• �O F�/ I p / ADDRESS ! -C, 13®)C 106 <br /> CRY/ZIP__ VEKNA�-0 (S-7. 7 PHONE NUMBER <br /> CONTRACTOR j?O/Q )/[. �5�1�� ADDRESS p to Ia49) 37R.4- <br /> CITY2IP a/Z PHONE PHONE NUMBER�(� <br /> GEOGRAPHICAL INFORMATION: COORDINATES: % Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUWER OF EMPLOYEES: <br /> ❑ DESTRUCTION Ll OTHER <br /> ElRJ - ������ <br /> ENGEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY 1 APPLICATION IS <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPEJMFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: OISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE V <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DISTANCETOREARE.CT: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DiSTANCETONEARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH oISEAnCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISGNCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER_ DEPTH DISTANCETONEARECT: WELL FOUNDATION PROPERTY LINE O <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS $T <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. / <br /> MI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE: C9t4WE2 DATE: �L Z'-02 <br /> �..._; <br /> -t - 1 t <br /> f � . _ 1 <br /> I <br /> � yy <br /> { ~ <br /> i. <br /> t <br /> t- tv , �' L'_... i .. <br /> t <br /> t � r + <br /> u c n I;f •wc <br /> DEPARTMENT UU(S�E ONLY 'I{,� Y i IE�I`/�� <br /> APPLICATION ACCEPTED"': WEA// I C DA/T`E:4�j 'AC7- Y' AREA EMPLOYEE IN �V/VO DISTRICT LOCATION <br /> INSPECTEDBY: J�[u \ . ) C DATE: I 1 A/ v �PERMITFINAL YES DATE: a INSPECTOR: <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT CHEC ASH RECEIVED DATE PERMDISERVICE REQUEST# INVOICE* SEPTIC IN <br /> REMITTED BY <br /> Zu 5Z1 '2 00 30 41 4- <br /> _3 � <br /> REVISED M.ICBI <br />