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/oyP7 <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 301 E.WEBER AVE 3R'FLOOR,STOCKTON,CA 95202(209)46R-3420 <br /> r L. IY <br /> I W1O REFUNDABLE PERMIT EXPIRES�1 NEAR FROM DATE ISSUE �y <br /> JOB ADDRESS �1.+- / �f.✓tom / ' 1C APN IV /62 <br /> O S V _ �dr /`PARCEL SIZE:�tA <br /> CITVIZIP AL 1 (y Q � BUILDING PERMIT e v v v <br /> OWNER NAME Q.If- ( DnCS ADDRESS '� P <br /> I. / 8� - .W H I { <br /> CITVIZIP Sod r L .�C PHONE NUMBER 51_ 74 <br /> / o <br /> r CONTRACTOR d -1 �Ly y rj-f ADDRESS !o / l/j/ F `Z m <br /> CITY/ZIP 4-O L �TDy 5 .2 / 4,; PHONE NUMBER 7 7 sof G/� /�G3-/S�'` <br /> x. GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> Tx NEW INSTALLATION 'X RESIDENCE NUMBER OF BEDROOMS: <br /> .. ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: L <br /> ❑ DESTRUCTION LlOTHER <br /> L ❑ ENGINEERED/ALTERNATIVE { <br /> CHARACTER OF SOH.TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> c <br /> ❑ PERC TESTS) HOW MANY .f II /l APPLICATION# �1 <br /> SEPTIC TANK TYPE/MFG_ `} b c v 4 e CAPACITY I�o OO #OFCOMPARTMENTS iG <br /> ❑ GREASE TRAP TYPEJMFG CAPACITY #OFCOMPARTMENTS n <br /> G <br /> C <br /> ` ❑ PKCf%PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE _ <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> ❑ LEACH LINE #OFLINES:3_LENGTH OFLINESI,�& DISTANCETONEAREST: WELLl'!jr? FOUNDATION" PROPERTY LINE j <br /> I NFLITRATOR CHAMBER'S: C <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DINTANCETONEAREST: WELL FOUNDATION PROPERTY LINE r <br /> Ll MOUNDED WIDTN LENGTH DEPTH-` DISTANCETONuaEST: WELL FOUNDATION PROPERTY LINE l <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DISTANCETONEAREW: WELL FOUNDATION PROPERTY LINE <br /> C <br /> ` ❑ DISPOSAL PONDS WIDTH . LENGTH DEPTH DISTANCETONEARESI': WELL FOUNDATION PROPERTY LINE (( <br /> ❑ SEEPAGE PITS # DIAMETER 11-4 DEPtH�5` DISTANCE TO NEAREST: WELIJ FOUNDATION /0 PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> b. AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM 24 HOU ADVA E Ny9710E REQUIRED FOR INSPECTIONS-PLEASE <br /> ,C/J�LL(20 p 468-3423 <br /> SIGNED: /�Lrv+-t.c.( !(��_ TITLE: T .1 DATE: <br /> I I <br /> f <br /> FFC Ela <br /> ' 1--d ... � o-..._ -. IFN17 R`ONMFNA4t�NfAI�H <br /> I <br /> _ <br /> "4dViRI1 if -. <br /> _i <br /> I <br /> -I , <br /> 1 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPT Y� _ DATE: a �a -)-AREA,y`f f EMPLOYEEIDS DISFRICT LOCATION <br /> INSPECTED BY / DATE:�O/'�OZ PERMIT FINAL YES DATE: !O/�'/«'INSPECFO - <br /> COMMENTS. <br /> PECODE SC INFO AMU 4tLCRlCASH RECEIVED DATE PERMITSERVICE 0.EOUESTM INYOICEx SEPTIC IOx <br /> REMIT' BY <br /> if f f r7 3 z4 2' 7��- S 0031 3 l <br /> RevrseD R-ISII <br />