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€/ LIQUID WASTE PER <br /> JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEN ;HEALTH DIVISION <br /> 304 E.WEBER AVE 3R"FLOOR,STOCKTON,CA 95202(209)46x-3420 <br /> I. <br /> NON-R 'FUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �C. / - <br /> /d/ <br /> APN � � � PARCEL SIZE: <br /> i CII-YIZIP �G BUILDINCPERM[T# - <br /> ir <br /> owN£RNAME <br /> ADDRESS <br /> C1TVtZIP PHONE NUMBER <br /> CON'T'RACTOR - ADDRESS <br /> i PHONE NUMBER c,3! <br /> i GEOGRAPHICAL INFORMATION: COORDINATES: X <br /> " Y-- TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: <br /> ❑ NEW INSTALLATION �f INSTALLATION WILL SERVE; <br /> I. NUMBER OF LIVING UNITS: <br /> I' RESIDENCE <br /> f REPAIWAI)DITIONCOMMERCIAL <br /> I N UM BE R OF BEDROOMS: <br /> ❑ <br /> 1 LI DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES; <br /> I I <br /> i ❑ ENGINEERELVALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: <br /> f` PIT1SUMp SOIL CHARACTER: <br /> WATER TABLE DEPTH: <br /> )k <br /> LJPERC TESTS <br /> O HOW MANY APPLICATION# <br /> {1 <br /> SEPTIC TANK TYPE/MFG_ r�.�' CAPACITY TY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY <br /> p #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL <br /> FOUNDATION PROPERTYLINE <br /> © LIFT STATIONI} <br /> SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> A LEACH LINE #OF LINES:_L�LENGTH OF LINES: <br /> U. )�/�! D) <br /> DISTANCE TO WELL G L✓-#' FOUNDATION Yf) ]. PROPERTY LIN£ZC� " <br /> INFL[TkATOR CHAMBERS: '—f'-'� <br /> ❑ FILTER BED WIDTH LENGTH DEPTH bISfANCE TO NEAREST: WELL <br /> i - FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH - LENGTH DEPTH <br /> k - DISTAN'CETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL <br /> I',i PROPERTY LINE FOUNDATION <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> , DISTANCE iONEAREST: WELL FOUNDATION PROPERTY LINE �• <br /> � SEEPAGE PITS # C�I'I ��f H���l � <br /> �..� DISTANCE TO NEAREST: WELL 6 ATION FOUND �SFWT! fr 1LJ <br /> . DIAMETER DEPTH - G/' " PROPERTY L1NE��f� <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> i8 AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOU ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(ZD9)468-3423 <br /> fI <br /> SIGNED: <br /> TITLE: DATE: <br /> E f ' <br /> - <br /> 1 <br /> .i- <br /> .,.. .., ..,.. - - .. <br /> .. _ ., <br /> ...., <br /> 4. <br /> . ..\ ..., a.. ...... .... ..... <br /> .,..... <br /> r f <br /> i <br /> I <br /> e ....., ..,. <br /> f <br /> _ I -. .,..,... 1., <br /> . <br /> r.-.,..,I ..,., .... .., <br /> .... RA4YM EN7 <br /> s <br /> i <br /> r.... <br /> IED <br /> EFIV <br /> :... <br /> ...c.. <br /> AN J�)AQUIN.C.QUN.CY..: <br /> f Nl <br /> DEPARTMENT Us EO .Y <br /> APPLICATION ACCEP Y' ' <br /> „DATE: AREA Z _-EMPLOYEE IDYi-!; � DISTRI LOCATION <br /> INSPECT + - _DATE' J� J HHH-------- <br /> PERMIT FINALA^ YES DATE:-- <br /> INSPECTO ' <br /> COMMENTS: "`+LXX Q'L <br /> ii <br /> :4 <br /> PE CODE SCiNFO AMOUNT ECK71f ASN RECEIVED OATS <br /> REMITTED BY PERMITlSERVI QUEST# INVOICE# <br /> SEPTICIDN <br /> REVISED S-fypl p <br /> �'p <br />