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LIQUID WASTE PERM"'' <br /> vIOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONME�/HEALTH DIVISION <br /> 304 E.WEBER AVE P'FLOOR,STOCKTON,CA 95202(T146S-3420 (/� <br /> f NON-RE NDABLE PERMIT EXPIRES I YEAR 3 DATE SUED <br /> O© CJ PARCEL SIZE: /qs-' 6 <br /> JOB ADDRESS � �y�� / ,M) 1 1-ha f>Vb APN <br /> CITY/ZIP ;$ / / WA D e Al/Al � BUILDING PERMIT 0 ^e ,,F <br /> OWNERNAME kjI2- l jPd N I JSZ J R NA/ ADDRESS ca Kp.D�70 'mIA (� <br /> Lt(� y <br /> CITY/ZIP stoc kb PHONE NUMBER /J �(�20 EAT / <br /> CONTRACTOR <br /> J, /IP:U OL��IFYIIN C, ADDRESS G -2V]] / r <br /> CITY/ZIP Sfocl��'o/� �� ' `� PHONE NUMBER /3J' 1G qz q% lD l <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: '., NUMBER OF LIVING UNITS: <br /> Sl NEW INSTALLATION 3 RESIDENCE NUMBER OF BEDROOMS: _ <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER 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 �1 n APPLICATION# <br /> SEPTIC TANK TYPE/MFG CON LF "+e CAPACITY #OF COMPARTMENTS_ <br /> /❑ GREASETRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1 /� ,F <br /> Ek LEACH LINE #OF LINES:�LENGTH OF LINES: DISPANCETONEAREST: WELL 1 ed- FOUNDATION PROPERTY LINE 744- <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISFANCETONEAREW: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ DIsrANCETONEARLW: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETO NEAREW: WELL FOUNDATION PROPERTY LINE 4 <br /> ❑ DISPOSAL PONDS WIDTN LENOTH DEPTH DIWANCETONEAREW: WELL FOUNDATION PROPERTY LINE C <br /> [j N � � Cq SEEPAGE PITS #� DIAMETER 12 DEPTH Z� DISTANCE TO NEAREST WELL FOUNDATION PROPERTY LINE, <br /> I HEREBY CERTIFY THAT I 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 /> MINI11 24HO RA V CE OTICE REQUIRED FOR IN TIONS PLEASE CALL(209)460-3423 ..i�JJ <br /> SIGNED: //! 7 /9'Y7 b �' E: DATE: I- .CQ`d; C <br /> Ll <br /> -� —fir t� �w�r :G � rt-1 ...................I _. <br /> 1 <br /> 1 <br /> + { a <br /> ... ..... ... <br /> 114 9\!Eta - <br /> I �— <br /> _ t. <br /> -a - - <br /> JI AUUIN{,.JI,NT ! � <br /> I .. - { •-_-. . . ....-.. ..-_4vO NT <br /> P4DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTD BP. C4 DATE:Hs_Zo //WEA EMPLOYEE IDM OISTR/ICT, LLOCATIOON(;� <br /> PERMIT Fl `� _' <br /> INSPECTED BY: 11 <br /> n^�' � j <br /> a INSPECTOR <br /> COMMENTS' vote W '(/ is <br /> PECODE SC INFO AMOUNT CHEC CASH RECEIVED DATE PERM RSERVICE REDUEST0 INVOICE# SEPTIC IM <br /> REMITTED BY ' <br /> ZI 3"a <br /> REVMED.1-NI <br />