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LIQUID WASTE PERM <br /> SAN IOAQU IN COUNTY PU9L1C HEALTH SERVICES ENVIRONMEN ALTH DIVISION <br /> , R 104 E.WEBER AVE 3'I'FLOOR,STOCKTON,CA 95202 C T3420 <br /> ' <br /> 1 ^ NON-REFUNDABLE PERMIT EXPIRES I YRAR FROM DATE ISSUED v <br /> JOB ADDRESSJQ&O4 LIAI AIF Z4 APN 25 t)I�'� I �- PARCEL SIZE:Z,✓_ <br /> CITYIZH` BUILDING PERMIT 4 R - <br /> OWNER NAME - ADDRESS 105 O LI rj 1-j� <br /> CITY/ZIP _ 'SA'MFt Ar+ - J4 PjQy PHONE NUMBER <br /> ' CONTRACTOR_,_. n ArjQEa�,A ASSY—ADDRESS ie 62 VIM OL) <br /> CSTY1ZIP LdD� PHONE NUMBER � ) 3L,7-,3?0'( <br /> r - GEOGRAPHICAL INFORMATION: COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK; - I INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> I ❑ NEW INSTALLATION ZI RESIDENCE - NUMBER OF BEDROOMS: <br /> Cl REPAIR/ADDITION Cl COMMERCIAL - <br /> �' � ❑ DESTRUCTION CI OTHER NUMBER OF EMPLOYEES: _ <br /> a C,} ENGINEEREDIALTERNATIVE <br /> CHARACTER OF SOI).TO DEPTH OF 3': PITISUMP SOIL CHARACTER: - WATER TABLE DEPTH: <br /> 4 , <br /> PERCTEST(s) HOW MANY APPLICATION# <br /> 4'. ❑ <br /> SEPTIC TANK TYPE/MFG— CAPACITY 4 OF COMPARTMENTS _ <br /> C7 CREASE TRAP TYPEJMFG CAPACITY OOFCOMPARTMENTS <br /> x ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION` PROPERTY LINE - <br /> it Q LIFPSTATION SIZE TYPECFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> .0 LEACH LINE #OF LINES: LENGTH OF LINES: D STANCETO NFARLM WELL FOUNDATION - PROiFF.RTY LINE <br /> 1 INFLITRATOR CHAM HERS: - <br /> ❑ FILTER DED - WIDTH LENGTH DEPTH OTNTANCEYONLARL1T; WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIATANCFTDkEA.LWj WELL FOUNDATION PROPERTY LINE .O <br /> ❑ SUMPS WIDTH LENGTH - DEPTH otkTAnCG TONEAREST: WELL FOtINOATIUN PROPERTY LINE - <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH 0$STANCETOPEARLST: WELL FOUNDATION PROPERTY LINE <br /> 1p ❑ SEEPAGE PITS # OPAMETER DEPTH oscTAIETa N'LARLST: WELL FOUNDATION PROPERTY LINE [� <br /> _ y\ <br /> ' � I I HEREBY CERTIFY THAT J.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 /> ' 1NINIUM 24 HOUR ADVAN E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> P , SIGNEU: TITLE: /ELa7 72z_g- DATE: s�zln <br /> { i <br /> LA <br /> 65 iz� <br /> 7 <br /> — <br /> _ o. — <br /> ,I <br /> + — <br /> -- f. <br /> / <br /> y _.._._. .� .._�. .....__-._._��....�_•-------- _.. I'll'11L.1771��{iI,, -. <br /> c <br /> DEPARTW. <br /> 'USF;CIN), <br /> L AI'I'L:CATION AL'CEI'TED PY, _ DATES�-'_^"_� REA•�` EMPLOY E IDx�✓ DISTRICT LOCATION <br /> INSPECCED BY: />lA�/-•—�'� DATE' r PERMfT FINAL�YE5 DAi5/ U fNSPECTOR: <br /> I� , CUMMEN75'�N/!/F"�a" <br /> PECODC SC INFO AMDUNT (-NEC CASH <br /> 9EMITTCD Y <br /> RECEIVED GATE PERMITrSErtvICE REOVESTx INv01C[4 SEPTIC1Dx <br /> r � � 0 ^. <br /> 176, <br /> x <br /> ' REVISED x_I I.Fs <br /> I <br />