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s.>, ..-:wwe,ew - .•.:,�:*',x.-s /.;#:., a;-.ie-s'r,. ;44:�0.14 Fe4i..,RN•tfida,,.- 6 ,. . 1 ,. .- ,,.'.tiiF"°;. 3,i�.i.,rjdnr^.,, L'. - <br /> LIQUID WAE PERMIT. <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HLALTH DEVISION <br /> 304 E.WEB£R AVE 3""FLOOR,STOCKTON,CA 95202(249}46K.1420 - - - <br /> y DABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED _ <br /> JOB ADDRESS I �' 1L' l � �.1���� -' - APN � C� L C��'� I J .-, PARCEL'mm ' <br /> �F� '° CITYIZIP (�% �.�.f'.v1 BUILDINGPE.RRVHT# <br /> { OY\TER NAs1E `\ 11•• �" `+' AaaREss 1 l_'••' if��C�� LV�I -- - <br /> 1E 1 <br /> l{\,� <br /> CITYIZW {� PHONE'NUMBE <br /> RL <br /> CONTRACTOR i ..i_ 1, it lye 'c` - } ADDRESS .rri: 4 yC�ES r.#LY-I <br /> PHONE NU'A16EA ,L.✓�I' `' <br /> GEOGRAPHICAL INFORMATION: COORDINATES',.X - Y - TOWNSHIP RANGE SECTION - <br /> TYPE OF SEPTIC WORK: - INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS _ <br /> u D NEW INSTALLATION - -'Q RESIDENCE. _ '_ NUMBEROFREDROOMS. �x <br /> D RRPAIRIADDITION D COMMERCIAL ! <br /> - - NUMBER OF EMPLOYEES: - <br /> L) DESTRUCTION ❑OTHER <br /> ❑ ENGINEEREDIALTERNATIVE - - - - - --- <br /> Fj .CHARACTER OF SOIL TO DEPTH OF 3': PiTlSUMP SOIL CHARACTER: - ,WATER TABLE DEPTH: - <br /> PERC TEST(S) HOW MANY 1 -APPLICATION q�S n -0 1~ q 2�, <br /> Cl SEPTIC TANK T�'PEIMFG CAPACITY OF COMPARTMENTS <br /> �+ 13 •'GREASETRAP TYPEIMFG - - - - CAPACITY - - 0OF'COMPARTMENTS ! <br /> ❑ PKGT%PLANT _ DISTANCE TO NEAREST. WELL FOUNDATION _ PROPERTY LINE <br /> - ❑.�' LI F7 STATION SIZE TYrE OE rtAr SAND'OIL SEPAR ATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE:' -H OF LINES. LENGTHOF LINES DISTANCL TOnEARER: WELL FOUNDATION PROPERTY LINE - I <br /> '. INFLITRATOR CHAMBERS: - - - <br /> El <br /> ❑ .AILTERBED WIDTH - 'LENGTHDEPTH DMANCETONLADrhTI WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH - DEPTH DISTANCETO NEAREST: WELL FOUNDATION - -PROPERTY LINE' <br /> ❑ SUMPS WIDTH- LENGTH DEPTH MITANCETONEAREATI, .-WELL FOUNDATION PROPERTY LINE V <br /> ` LSI. DISPOSAL PONDS WIDTH LENGTN DEPTH DIYTANCe Ta NEAREsr; WELL FOUNDATION PROPERTY LINE yy <br /> i <br /> ❑� SEEPAGE PIT'S /! DIAMETER DEPTH DISTANCE TONEAMST:, WELL FOUNDATlow PROPERTY LINE- L.. <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAW'S <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY: <br /> Yf1 I - $1. 'MUM 24,HOUR ADYANCIl$NOTICE REQUIRED POR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> L'( SIGNED. TITLE:4a,z-f(71�.� DATE:�L.. C <br /> _ a <br /> ALI I -i l- I i I N. <br /> _ j <br /> J <br /> ......... <br /> . i _ <br /> ...... <br /> A .............. .. ............. <br /> E <br /> Fl I L_ I I .:. _ 1 ._ l....._. <br /> �_ _ <br /> Imo: fi. r !I- - <br /> fi' I _ J <br /> Imo} 1 __i <br /> I 1 <br /> 77 <br /> s <br /> 3 sB c!�E�i�Hsl N <br /> ' (J���•'}/ �I (}��y /� DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BY: U F4.1 11 l I Y 3NLCO/� DATI REA_ _ _EMPLCYEE Dl_!64 4 DISTRICT�LOCATION <br /> INSPECTEDBY.' - -DATE: PERMITFINALO YESOATE', INSPECTOR' <br /> COMMENTS: , <br /> N <br /> P <br /> 'fECODE SC INFO - AMOUNT CHECKA: SHREGEI\'ED DATE 1,,y rEx rL5ERVICE REOVESTA: WVOICE" SEPTIC it7Y <br /> REMitt ED '•EY <br /> Fiji: <br /> RE1'ISE➢�li.4t - ' <br />