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SANJO.AQU`13COUNTIQUIHEY PUBLIC ALTH SERVICES ENVIRONMENTAL WASTE PERMIT H`1!I:VHDIVISION <br /> 304 E WEBER AVE.,3X0 FLOOR.STOCKTON.CA 95202 (2(1))468-3420 24 H Fi e\ D e f <br /> N N-REFUNDARLE PI RM' E PIRES I YEAR FROM DATE ISSUED FR Etj 1_:"xL':a A EED <br /> 3a(,,3 l'h�CO FC_) ALA_ <br /> IBB ADDRESS INSPEG.�. � TON <br /> CITY/ZIP,/ �_1�_ /VN P RC^EL SIZF/APN G/ Q <br /> OWNER NAME /L[��Sl�/YI Fa.rM 5 ADDRESS. [7 % <br /> CITYMP ��h PHONE /��t�n <br /> CONTRACTOR }!�t/ //� f 5 _ ADDRESS'goo <br /> N•ptu1bc" <br /> CITY2IP J(lL-L/U "1 %J Jw PHONE "I l.�� c?&V / <br /> GEOGRAPHICALINFORMATION: COORDIANTES: X Y TOWNSHIPRANGE_SECTION <br /> PERC TESTIS) ( ) HOW MANY APPLICATION N: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION DESTRUCTION <br /> INSTALLATION WILL SERVE: 13 RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OFSOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPT IC TANK/GREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS- <br /> 0 PKG TREATMENT PLANT <br /> OMPARTMENTS❑PKGTREATMENTPLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES I INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE. <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE " <br /> ❑DISPOSALPONDS WIDTH LENGTH DEPTH N <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Zl- <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE:_ --DATE: <br /> — <br /> Zs- <br /> - <br /> 0 <br /> rt <br /> n <br /> 00-01 <br /> 000 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY: DATE ^� i <br /> Icy <br /> TANK.PIT.OR SUMP INSPECTED Y: DATE. •�/�• <br /> FINAL INSPECTION <br /> COMMENTS. <br /> PECODE I SC I AMOUNT IEC RECEIVEDBY DATE PERMITISERVICEREQUESTX SEPTIC IBX <br /> INFO REMITTED SH <br /> z z2 <br />