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LIQUID WASTE PERNIIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION —,.Tc <br /> JOAE.WEBERAVE3°'FLOOR,STOCKTON,CA%2D2QW)46R-3420 i` <br /> N;-REFUNDABLE PERMIT EXPIRES I YEj FROM DATpE I$$UED%U <br /> JOB ADDRESS -0[/ / Y]2 _T/ 'G2 I'LO. pPN �L��a/1D / / PARCELSITE: 1/ <br /> AI <br /> CITY/LP IFSC7,420 2 BUILDINCPERMITM <br /> OWNERNAME B!u(( �- /r7�p//b� �MnC( �Y.rGW9 ADDRESS pO�� <br /> ` CITYILP��y A �A6o 1�G <br /> 64DE/e/.11 Y4 PHONE NUMBER -09�rT R/ 6 <br /> CONTRACTOR 9YlD� MW4a Gr ADDRESS <br /> Cal( �T <br /> CIT)'YLIP PHONE NUMBER god S`♦TJ'� ��O 9 <br /> GEOGRAPHICALINPORMATION: COORDINATES:% —Y—TOWNSHIP—RANGE SECTION <br /> TYPEOFSEPTICWOR : INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ <br /> ` ANEW INSTALLATION yyy❑,,, RESIDENCE NUMBER OF BEDROOMS: <br /> L) REPAIRIADDITION gCNUMBER OF EMPLOYEES: <br /> COMMERCIAL <br /> ❑ DESTRUCTION '13\OTHER _ <br /> ❑ ENGIREEREDIALTERNATIVE � <br /> ` CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATERTABLEDEPTH: <br /> ❑ PERCTFsTIS3 HOW MANY QPPLICATIONM <br /> 2 <br /> L SEPTICTANK TYPE)MFG !r tP CAPACITYMOFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY MOFCOMPARTMEWS <br /> ❑ PKCTX FLAW DISTANCETQNEAREST: RELL FOUNDATION_ PROPERTY LINE <br /> ❑❑// LIFTSTATON SIZE TYPEOFPUMP SAND OIL SEPARATOR(MCLOSED SYSTEM) <br /> ''') <br /> RPK LEACH LINE MOF LINES: ! LENGTH OF LINES: ouTAnniax[A0.e.R. WELL ' FOUNDATION PROPERTY LINE <br /> ` INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ outnncem xuR[n: WELL FOUNDATION PROPERTY LINE_ <br /> ` - �OMOUNDED WIDTH ���TTT IFNOT1 DEPT_ DMANCETON[ARLR. WELL <br /> FWNDATION PROPERTY LINE <br /> / <br /> SUMPS WIDTH LENGTH_ OEPTH� •TONG0.[Sl. WELLS+ FOUNDATION PROPERTY LINE <br /> E ❑ DISPOSAL PONDS WIDTH IENGTN_ DEPTH IRR NR NGRUT. WELL FOUNDATION PROPERTY LINE L <br /> ` ❑ SEEPACEPITS M DIAMETER_ DEPTH` DIiTWCEMNGR : WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFYTHAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE W W$ <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ��MNIMUM3414 CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20)46&3423 <br /> SIGNED: GG[[++((/pYf__ TITLE:tR a DATE:6 GILT BI' ) <br /> s I D r <br /> ------r EF- <br /> 9 - <br /> L <br /> L <br /> � A <br /> LDEPARTMENT <br /> APPLICATION ACCEPTED BY: SENLY''D''AAyTE:I2''. OI AREA yEMPLOYEEId9a 7�t d6TRICT LOGTION <br /> INSPECTED BY: , DATE PERMITHNALWIUSOATE: INSPECTOR: <br /> COMMENTS: WO E <br /> N C+ <br /> PECM6 WINFO I AMOUNT CHECDY 14 I.EIVEO DATE PE0.MR5ERVICE 0.EQUFbT[ MVOICEY SEVTICid. <br /> RFMITPED nY <br /> &12-1(D 21'D <br />