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L LIQUID WAGE PERMIT <br /> SAN MAQUIN CWNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> IN E.WEBER AVE 1"'FLOOR,STOCXTON,CA 1620212EN1MRJ<l0 <br /> NON-RE DABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS [/�E2 IT/ APN <br /> ff�II -- I � r� OD—[J / PgBCEL31Zq:�C 5 <br /> CITY21P `eee��Ol� BUILDING PERM`IT/1N/I <br /> O\VNER NAME l[/'V`� ADDRESS /[T <br /> 6. CITY2IP <br /> PHONE NUMBER <br /> COMC00. ADDRE$� <br /> LCINZP PHONE NUMBER <br /> l GEOGRAPHICALINFORMATION: COORDINATES:X OWNSHIP_RANOE SEC ION <br /> TYPEOFSEPTICWORK: INSTALLATION WILL SERVE: NUMBER OF LWING UNITS:_ <br /> ❑ NEW INSTALLATION ❑ RESIDENCE <br /> .@'REPAIRJADDITION NUMBER OF BEDROOMS: <br /> ( COMMERCIAL <br /> ❑ DESTRUCTION /❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> ` CHARACTER OF SOIL TO DEPTH OF 3•' PITJBUMP SOIL CHARACTER WATER TABLE BEPTH <br /> ❑ PERCTESTI31 HOW MANY APPLICATION# <br /> ❑ SEPTICTANR TVPEIMFO CAPACITY #OF COMPARTMENTS <br /> B. ❑ GREASETRAP TYPE/MFG CAPACITY NOFCOMPARTMENTS <br /> ❑ PRCTX PLANT DISTANCETONEAREJEE; WELL__ FOUNDATIONLI <br /> _ PROPERTY NG <br /> 13LIFESTATIOM SIZE TTE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> URI, LEACH LINE #OF LINES:1LENGTH OF LINES: pmANf[TDNEANJD: wFLL L Z22POUNUATIo' <br /> INFLTTRATOR CHAMBERS: "�' PRMERTT LINF� <br /> ❑ FILTER BED WIDTH_ LENGTH_ DEPTH_ DmiAnC[TONEARFAE: WELL_ FOUNDATION_ PROPERTY LINE_ <br /> ` ❑ MOUNDED WIDTH LENGTH DEPTH_ p:RiAxfETpnIA0.PT: WELL FOUNDATION PROPERTY LINE_ <br /> ❑ SUMP$ WIDTH_ LENGTH_ DEPT1_ DMTANC[TO N[AROND WELL FOUNDATION .PROPERTY LINE_ <br /> ❑ DISPOSAL PONDS WIDI LENGTH DEPTH_ oRAn¢iO NeAapT: WELL FOUNDATON_ PROPERTY LINE_ <br /> IFS �JSEEPAGE PITS DAMFTRJ I OEPTNI pIFTANFTOM[AR6¢T: WEL1 FOUNDATKIN & JTTLV <br /> ( / D <br /> IHEREBYCERTIPYTHATI HAVE PREPAREDTHIS APPLICATION ANDTNRWORKWILLBEDOME INACCORDANCE. $AN JOAQUIN COUNTYORDINANCES,STATE LAW$ <br /> AND RULES AND pEGUL'ATIOH$OFSAN JOAQUIN COUNTY. <br /> ` M 124 RA NOTCC ICE REQOIRED FOR INSPECTIONS-PLEASE CALL 1209)"A-3431 <br /> p{ SIGNED: TITLE: DATE:3 -Z 7-6 L <br /> p 4 <br /> L � <br /> 1 <br /> P 14.11.HF 111 <br /> LDF.PA M 1DREONNlLY //�A — J <br /> AKLICATION ALCEPTEp BV; TRrG/ 7-�/Y AREA EMPLOYEE IOT'���pISTRICf T'z LOCATION I <br /> INSPECTED By, <br /> DATE: �(/�PERMIT flNAL OF YL4 DATE: /1 {IN$PFLTOR: <br /> LCOMMENTS <br /> I'F[oM KI O AMOUNT ,VN RECEIVED DATE PERMRBERVICE REQUF�F INVOKE[ SEPTIC IM <br /> REMRVEO DV <br /> L y215 ��a 350 <br />