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LIQUID WASTE PERMIT <br /> SAN J�IN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL I� /tH DIVISION <br /> ?D4E.WEBER AVE 3XO FLOOR,STOCKTON.CA 95202(209)4fi 0 <br /> �A�j � NON-REFUUJNDABI.F.PERMIT EXPIRE'S 1 YEAR FROM DATE <br /> ISSUED Q/ <br /> JOB ADDRESS ,� �JJJ BE�L>r7/1 L/' APN 26.3 /6-0h3(- PARCEL SIZE: / <br /> CITYlZIP i✓ T BUILDING PERMIT, ("/ / d -717 52, <br /> OWNERNAME ,( ADDRESS (� .J /� <br /> CITY/ZIP PHONE NUMBER ✓°f- C / 5/ ^ `/C f�'J0 / <br /> CONTRACTOR f �/� / N ADDRESS .77/11— 1R'�, �• <br /> r� <br /> CITY/ZIP dJ-(��//- AA �� PHONE NUMB�RRf (�dJ / /✓ �// <br /> 1 T <br /> GEOGRAPHICAL INFORMATION: COORDINATES: % Y TOWNSHIP RANGE SECTION <br /> T YPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> W--NEW INSTALLATION RESIDENCE 11 <br /> NUMBER OF BEDROOMS: <br />❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br />❑ DESTRUCTION LlOTHER <br />❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 37PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br />❑ZP cTEST(S) HOW MANY APPLICATION# <br /> SEPTIC TANK TYPE/MFG C (�� CAPACITY /J 00 #OF COMPARTMENTS .7— <br /> GREASE <br /> GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br />❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> c�c f •7 <br /> LEACH LINE #OFLINES: J LENGTH OF LINES:�'F L� DISTANCE TO NEAREST: WELL FOUNDATION d(-A PROPERTY LINE ,Lf <br /> INFLITRATOR CHAMBERS: <br />❑ FILTER BED WIDTH LENGTH DEPTH M. ANCE TO NEARBNT: WELL FOUNDATION PROPERTY LINE <br /> Cl MOUNDED WIDTH LENGTH DEPTH DTSTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br />❑ SUMPS WIDTH LENGTH DEPTH DRANCETONEARCST: WELL FOUNDATION PROPERTY LINE <br />❑ DISPOSAL PONDS WIDTH LEINGTH DEPTH DISTANCETONEARENT: WELL FOUNDATION PROPERTY LINE <br />❑ SEEPAGE PITS IS DIAMETER DEPTH MSPANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBICERTIFY 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 /> >INIMUM 24 e U A NE ICE REQUIRED FOR INSPECTIONS—PLEASE ALL(209)468-3423 ,,II / <br /> SIGNED: TITLE: D h R DATEAZ (� O <br /> well kr/ <br /> 7� f F .. <br /> L ImN' <br /> w <br /> 4 I <br /> I � <br /> I <br /> aj i a <br /> 1 <br /> 1-1 s S <br /> z <br /> f <br /> r <br /> I- <br /> ) <br /> DEPARTMENT USE )NIA, p �/ <br /> APPLICATION ACCEPTED , DATE: d T AREA2�1 EMPLOYEE IDR /3 /y DISTRICT�cS LOCATION <br /> INSPECTED BY: E Y <br /> DATE: O O PERMIT FINALES DATE INSPECTOR: <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT CHECK,2 H I RECEIVED I DATE I PERMITISERVICE REQUEST, INVOICE, SEPTIC IDN <br /> REMITTED BY <br /> x-421 32b- '4-525 �z �R-oO�2 $ 1� <br /> EVISED 1415-01 <br />