|
LIQUID WASTE PERU -NT
<br /> JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMLi t HEALTH DIVISION
<br /> 304 E.WEBER AVE 3%°FLOOR,STOCKTON,CA 95202(4y,468-3420
<br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED
<br /> JOB ADDRESS -� APN , / O i PARCEL SIZE:
<br /> CITY/ZIP e,- ` !2� S BUILDING PERMIT#
<br /> ! �. �O "/�!I Ir %1!0 ADDRESS_
<br /> OWNER NAME
<br /> CITY/ZIP �( DCS L-tJ.rL� PHONE NUMBER ZO 3
<br /> CONTRACTOR / /L �4 zri�, ADDRESS C2 /',, F• C,�G/�G I S/• 14
<br /> CITY/ZIP !—A/ / PHONE NUMBER
<br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION
<br /> I �
<br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:
<br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS:
<br /> ❑ REPAIR/ADD1TiON ❑ COMMERCIAL
<br /> NUMBER OF EMPLOYEES:
<br /> DESTRUCTION D OTHER .
<br /> ❑ ENGINEEREDIALTERNATIVE
<br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: 'WATER TABLE DEPTH:
<br /> ❑ PERC TEST(SI HOW MANY APPLICATION#
<br /> ❑ SEPTIC TANK TYPE/MFG— CAPACITY #OF COMPARTMENTS
<br /> ❑ GREASE TRAP TYPEIMFG CAPACITY #OF COMPARTMENTS
<br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY'LINE
<br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM)
<br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: --DISTANCE TO NEAR&4T: WELL - FOUNDATIONS - PROPERTY LINE -
<br /> INFLITRATOR CHAMBERS:
<br /> ❑ FILTER BED - WIDTH LENGTH DEPTH DISTANCE TO.NEAREST; WELL FOUNDATION - PROPERTY LINE
<br /> ❑ MOUNDED WIDTH LENGTH DEPTH bISiANC9TONEAREST: WELL - FOUNDATION PROPERTYLINE -
<br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE
<br /> ❑ DISPOSAL PONDS WIDTH .LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE
<br /> ❑ SEEPAGEPITS # DIAMETER DEPTH DISTANCE TONEARE.ST: WELL FOUNDATION PROPERTY LINE }
<br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL HE DONE IN ACCORDANCE WITH-SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS •
<br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. r
<br /> U -:HOUR A CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423
<br /> SIGNED: TITLE: f/. DATE:
<br /> i I , I € I ' i ! 1 I I
<br /> h I I I 3 I I 7 I 3
<br /> I ,
<br /> a 1. I 1 _ l _1. 1 _.. ... ........ .......
<br /> ..,._..._ I, ' I
<br /> I I
<br /> I I 1 I 1 I' 1 I I 1 3„ f I „..,. I € I i { I f I_ f......_.,. _
<br /> - ..I- r Ill 17 i
<br /> p, 3 -{-- 1. I, _ __'�_.__..
<br /> I , I I I I I € I € I i , €
<br /> .__..._._..,.._............, _..,._.,._ �..-.,._ ..,._. .. 33 _ _ _ _ ._ _ _
<br /> I 3 {
<br /> ._...-:-......a..-_._ i.._.,L._, I f ....... ytF-!F^ .L:. .._.�.__'_ I _ 1 ..., ' _...... _ I � I !
<br /> E _...,. -._.
<br /> F I �
<br /> I
<br /> 1 yI 1 {` I
<br /> ' I - I I € I I I f I I --1 I.. f I f
<br /> _.._` r 4,.._._. 3 I
<br /> Y'_.__ _._.-h 'i............. �, I•--_-'�- = - 1 I_..,_ }, s J. ..._._._.I._............_._ i � - ........
<br /> ........ 1 I I, _... 1 - II II 1.._.,.... 1 t._,.__:_...._.{..._._._;_._.,.1 1 .,.-
<br /> 1 _ I 1 1 _.q__. } } . -
<br /> 1 I T _..,fi...:._..
<br /> .... ..I ., ._ ' ,.�.. - .` - ll ..._._I ..,.;, ' I I r I I S._._._......_.... ' I I
<br /> .3 1 I } 1 I -...._.f_T_. I I r [ ..-
<br /> Cr9 � { I r t 1 ,. I f 1 E �
<br /> I I
<br /> - I � E
<br /> I f I I I I I CAU
<br /> _ F-_ _._. _ _._- _
<br /> i I
<br /> I I ..._._._,.__. W.
<br /> f ...�... . ._ j..--'-' ..__._._ l �.. l- I. C. I t--._.I .-.- I I PU SIC kEEk N SY V"Es, 1
<br /> t I 1 I I , fi
<br /> I
<br /> -- i ---i. . i "J, I -, i t ._{ t 1 I t 't -- f �._ I -
<br /> € _K. 3 ' ..__ I I I I I I ..._._
<br /> :�- I-r--1 ._i -'1 -- _ .t...... ......... .....
<br /> t -r- I_ } �-i�i I l 1 .._
<br /> DEPARTMENT
<br /> SE NL0-
<br /> Y
<br /> APPLICATION ACCEPT Y - DATE:C? �/AREA ! EMPLOYEE ID,�.5Y415TR]CT C�LOCAT]ON �
<br /> INSPECTE BY DATE: / `[�J PERMIT FINAL IJ YES DATE: - INSPECTOR:
<br /> COMMENTS: //J CJCLyAyukzpw
<br /> I
<br /> PE CODE SC INFO AMOUNT CHECK#/ SH RECEIVED DATE PERMITISERVICE REQUEST# - INVOICE# SEPTIC IDN
<br /> REMITTED BY -
<br /> 22-
<br /> 07500 0 -D 3
<br /> REV ISED A-15-01
<br />
|