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LIQUID WASTE PEI ' -f JAN JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMUmmAL HEALTH DIVISION •� �� 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(209)468-3420 ^� N `-NON-R BLE PERMIT EXPIRES 1 YEAR FROM ATE ISSUED/ � �C JOB ADDRESS ?7(o7 - (•J APN V ' u PARCEL SIZE:_ CITY/ZIP l.1 I l �� BUILDING PERMIT k OWNERNAME- ��,�tiLl/lf'RM� ADDRESS I" W-+� CITY/ZIP PHONE NUMBER �/ CONTRACTOR ADDRESS !' I V �I�•�`�i� CITY/ZIP PHONE NUMBER GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ ❑ NEW INSTALLATION IDENCE NUMBER OF BEDROOMS: S9>EPA1R/ADDITION ❑ COMMERCIAL ( NUMBER OF EMPLOYEES: E) DESTRUCTION ❑ OTHER ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF Y&a�71PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: �Ch� 4r- ❑ PERC TEST ISI HOW MANY APPLICATION# ❑ SEPTIC TANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG r' CAPACITY #OF COMPARTMENTS ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ad LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ( #OF LINES: LENGTH OF LINES. (-`0 5 ff 7O O / EACH LINE .� DISTANCE TO NEAREST: WELL V FOUNDATION �V PROPERTY LINE 1 RA'OR CHAMHE ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDEDf WIDTH LENGTH. _ DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SUMPS " 'WIDTH ,.TH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH .. LENGTH DEPTH DI.STANCETONEAREST: WELL FOUNDATION PROPERTY LINE . / �1 EPAGE PITS #� DIAMETER ?>&`' DEPTH��I DISTANCE TO NEAREST: WELL/00 FOUNDATION 51-0 PROPERTY LINE S O / I HEREBY CERTIFY THAT I HAVE PREPARED THIS""APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. p MI MU �HO ADVAN TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 SIGNED: TITLE: DATE: i I --...+ ._..1_........i.._ ..,. i. .... .. 'r - .................... .. .. .I----_-.�__...._........ ._ I - .._...., ... .. ...._ 1.1..1 T ff t ...�...... f _ __. _ — 1 — _ I ........,.__.-__._................. ...............__._.._.._ .......-_..._...._.........__............_..L-.»_ 7 i 1 ...._.-....__...._..._.....�._.._ ..-.._ ..._..-....._............ ........__.__�-__..._.._................__......_....._._........ ' ..._.....f._..._....._...._........ -- -... .......f._........._.._....._..._................_.... .. - - __..._ .... �,- ...t ..._.1......._.._ _..... _ f- a. _f. ........_ . �_.. ___a___ . _ .__ —._ .. . . .. __. _ _ .................} — _ .._...... _. ._........._. m�::.. { r _ t . ... f j I_.... ...........---..................... .. ... ... .....j...... _. ... ... _._ ... ... ... _...... --' 1 ._._. ..... _._. ._. -._.. ..-_.... _. _. _....... _.. ._. _.. ._. ................._..._......_.. ........_.._..................� ....I... _..__......._._ ._......_.................__I-...............-�.......... ... ..._.� _i_....... ....�. .... ... ......... ................... ........ .. .... ........ ..... ... ........ .. ............_ ... .. .. ... .._ ... ... .. _.._ _.._ _._ .. _.._ .. 1 ._ .. _.._.._ f _. ..... ........ .........-......... ..............................___..... ........._......... .............................. j.................................._.1............ ._. .. .. _. � � 1......_ ...........I ....._... �.........�..._ I. ._.... ...... 1... ............. .. ................. . _.... ......... _ ....I ii I �._.._ ,.......... _.._..._..__ ....__......_......-............ ...._. . 1.........._:.._......i. V E -1—. a_._. - Ii '_...................._. `. 1 __....:..................._..._ - .. ..-......_....................._....._.f.._._ ....._.. ......__ -- - - { �...n-. _t_........_........_.. .._.... ._..._._.._I. �. .. _ .--....._1_..._...I— ... _......................_. __ ......... .._ ...__.. ... _......._. ._ _....... ... _... _ _ . . ........... I : ac. �.�s_ I I IRO M.ITA..1 H P TH .VI., r }.._.......1 -..�...-_ - ...4. ... .. iii ... .. .. 1 I _..... Q I : E NTOMNI APPLICATION ACCEPTED BY: v' /✓ �fEAEMPLOYEE ID#DISTRICT LOCATION_ INSPECTED DATE ✓ / PERMIT FINAL YES DATE: eNCTOR' COMMENTS: 015 7 PE CODE SC INFO e,rl AMOUNT .HECK ASH RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# SEPTIC IDN REMITTED BY REVISED 5.15-01