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LIQUID WASTE PERMIT <br /> t SAN JOAQUIN COUNTY PUBLIC REALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> t 304 E.WEBER AVE 3' FLOOR,STOCKTON,CA 95 202(2W)468.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DAT ISSUED <br /> JOA ADDRESS P <br /> PARCELSIZE:JQ ' <br /> Cll'Y1zIP BUILDING PERMIT# pG OT yl}(,� - #• <br /> OWNER NAAIF. ADDRESS <br /> CTT rzip PHONE NUMBER )� <br /> CONTRACTOR ADDRESS_ <br /> cITY17IP PHONE NUMB <br /> CEOGRAP H ICAL INFORMATION: 0OORDFNA7ES:X Y TOWNSHIP RANGE SECTION <br /> I'Yp'OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: _ <br /> NF,w INSTALLATION O RESIDENCE <br /> Q REPAIIUADDiTION ❑ COMMERCIAL NUMBEROFBEDROOMS: <br /> r ❑ DESTRUCTION O OTHER !q ] NUMBER OF EMPLOYEES: <br /> II ❑ ENGINEEREWALTERNATIVE <br /> r CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER; WATER TABLE DEPTH: <br /> I <br /> ❑ PERC TV FT.(S) HOWMANY APPLICATION# <br /> SEPTICTANK TYPEIMFO--� CAPACITY_.1Ld[3 #OFCOMPARTMENTS�r err <br /> ❑ OREASETRAP TYPENFG CAPACITY #OFCOMPARTMENTS 2.1 <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY uNE <br /> ❑ LIFTSTATION SIZE TYPE Or PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I ❑ LEACH LINE #OF LINES:_/_LENGTH OF LINES:24 WRTANCETONEARIDM WELL FOUNpATiON PROPERTY LINE <br /> L INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTI+ DEPTH DISTANCETUNTARLSr. WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENUTH DEPTH DIsTANCETONEARL, WELL F <br /> OUNDATION PROPERTY LINE <br /> F` ❑ SUMPS WIDTH LENGTH DEPTH DIWANCETONEARERT: WELL FOUNDATION PROPERTYLINE O <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH- DTaT. KTONEAREx WELL 'FOUNDATION FROPER7Y LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISFANCt TON1ARENT; WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTI PY THAT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCE%STATE LAWS <br /> AND RULES AND RECULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM �L� <br /> O CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3173 <br /> SIGNED: 2& <br /> TITLE: DATE:&- '�O <br /> 44 <br /> i 4---j I -i!S'EV <br /> 1171 <br /> I <br /> I � "7 <br /> -, - <br /> W - -{ <br /> -J__ I �- - --- <br /> i DEPARTMEJ� <br /> NT F, NLY <br /> APPLICATION ACCEPTED DY: DATE: AREA-2-1 IDEr IpISTRICf LO[ATI N <br /> —1 O <br /> INSPECTED BY: ATE: 0- PERMITHNALO YESDATE: INSPECTOR: <br /> COMMENTS: 31/0 <br /> PECDDE SC JN}d AMOUNT CHECIIr yN RECEIVED DATE PERMITl LRvICEREDUESTo INVOKER <br /> REMITTED BY PEPTIC]Do <br /> , <br /> RCV15Eo R.1�-11 <br />