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. , LIQUID WASTE PERMIT <br /> SANeQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTA% A/ALTH DIVISION <br /> 304 E.WEBER AVE 3R0 FLOOR,STOCKTON,CA 95202(209)41W3420 <br /> //yy�N NON-REFUNDABLE PERMIT EXPIRES 1 YFAR FROM DATE ISSUED <br /> JOB ADDRESS r]- F 1#/A('/SQ[JC,� APN J7 ^�6� •"5. PARCEL SIZE: <br /> CITY/ZIP � OC �'rrn J7., BUILDING PERMIT# <br /> OWNER NAME ,c/NQ <br /> /I ,p-11,n e 4(:•Y•3 /=.e ADDRESS PU <br /> CITY/ZIP �/N/cv �1Y PHONE NUMBERR� �� <br /> CONTRACTOR L�U �/11J1 7/PNp4�-7' '� ADDRESS �'�F'(� 0 •IRAJ !19 r <br /> CITY/ZIP 14C�r GC 14-Cr-r\ PHONE NUMBER 1�7� <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X V 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 /> T�E <br /> v,DESTRUCTION a LI NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TESTS) HOW MANY APPLICATION# <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS 11�A <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE y <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) (` <br /> `P(�./ <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES:_ DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE l <br /> INFLITRATOR CHAMBERS: <br /> ❑ <br /> FILTER BED WIDTH LENGTH DEPTH_ DERANCETONEARESf: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEARESP: WELL FOUNDAYION PROPERTY LINE `1 <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DISTANCETONEARE.Sf: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DUCTANCETONEARESf: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DMTANCSTONEARLW; WELL FOUNDATION PROPERTY LINE <br /> Z <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 /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANC NOTICE REQUIRED FOR INSPECTIONS-P +ASE CALL(209)468-3423 <br /> SIGNED: TITLE DATE <br /> I � <br /> I h <br /> I I i <br /> �.... �.-..- z 1. <br /> I <br /> $ _ OU T'I <br /> f <br /> i <br /> DEPARTMENT USE ONLY I� <br /> APPLI/CCAATTILWACCEPT6_DB R DATE; REAZiq EMPLOYEE ID#.�3�(0 / DIET LOCATION LI CI <br /> INSPEC Q BY-" l 1 % DATE: PERMIT FINALI V"YES DATE._ P 17-1 -r <br /> COMMENTS <br /> 'tea" wIl• /, _ .F. _ '. - '/� <br /> PE CODE, SC INFO FAMOUJYT H /C. H RECEIVED DATE PERMITSERVICE REQUEST# INVOICE# SEPTIC IDx <br /> -REMITTED BY <br /> 4ZZ ens � ,5R0�3o �. <br /> REVUSED WICDI <br />