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;e.. LIQUID WASTE PERAIA 7-0--4-1 o►, Gc <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 1 J(-� �• .WEBERAV 3" FLOOR.STOCKTON.CA 95202 <br /> (2(A))-068-7420 <br /> N N BL. HRMIT EXPIR S 1 YEAR FROM DATE•ISSUED <br /> JOB ADDRESS rhe R C <br /> � PPARCELSIZPJgpN_ <br /> OWNER NAME Me'�ri ADDRESS <br /> CITYIZIP Cl <br /> CONTRACTOR ` { PHONE-(2Z.;p5) Z.3q•-+�,,ZZ� <br /> --fi n" ` 1 JZO r�J• ADDRESS �I4 <br /> CITYafP kimlc <br /> PNONE13�a� 94%—i <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X <br /> Y_TOWNSHIP—RANGE <br /> _SECTION_ <br /> PERC TEST(S))� HOW MANY_I -- <br /> 7 YPE OF SEPHC WORK: – APPLICATION x: <br /> NEW INSTALLATION ❑ REPAIR/ADDITION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE 13 DESTRUCTION <br /> _ <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: XCOMMERICIAL ❑OTHER <br /> -- NUMBER OFEMPLOYEF.S: -5- <br /> CIIAItACI'IiR O1zSOIL TOA UIii'I'I101'.l 1'lili l': Si�. 0. <br /> PIT/SUMP S(111.CIIARACI'ER: WAIVE IABLEDRI'I'II <br /> ❑SEPTIC TANKIGREASE TRAP TYPE/MFG <br /> CAPACITY NUMBER OP COMPARTMENTS _ <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL <br /> FOUNDATION PROPERTY LINE _ <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / <br /> INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION <br /> 13 FILTER BED WIDTH PROPERTY LINE <br /> LENGTH DEPTH. <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPrH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE _ <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> - <br /> I HEREBY CERTIFY THAT 1 HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STA A ND ONS OF'SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE: <br /> N <br /> ....,. .. © <br /> ........, b L V <br /> ,.z zmu zozez xoxu O iee.z ii.a � .. <br /> r,•KL0 z s ,•A040 <br /> fnj• ie 1 II] d <br /> 3 y a <br /> POR. SW, 1/4 SEG. 14 AS. R.61- <br /> r (' SCALE I"•200' /J/ - <br /> SAN JOAQUIN COUNTY �••�5 /`�t1.y� A <br /> i - [ <br /> ASSESSORS MAPS - <br /> u <br /> F°\V\H ' FOR DEP TMENT USE pN1.V ' <br /> APPLICATION ACCEPTED By: <br /> t PATE: <br /> TANK,PR.OR SUMP INSP �Yh -J Cgar_tli -%' _ - -7jXfE: �- Z �!T <br /> FINAL INSPEff1 ry <br /> V. �/Q. '-!�l/lkf �� `•'�O���.�-„as7o ..l�1:iI�.J�.�r/�--1r7�-�J/!/�,,,_� <br /> COMMENTS: <br /> PECODE SC AMOUNT HCCKN RECEIVED BY DATE PERMR/SERVICE REQUESTN SEPTIC j� <br /> INFO RrMfl'IED A <br /> q 113,4-7jJ 2008 <br />