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' -QUID WASTE PERMIT <br /> y-1 SAN JOAQUIN C UBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E AVE 3a'FLOOR,STOCKTON.CA 95202(209)468-3420 `oll <br /> / <br /> AA NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE <br /> EIL <br /> ISSUED <br /> A (X� <br /> .JOBADDRESS II(oZn. S. mot-wL" yrm A. .oee,3 Z J`C/ 2 PARCELSIZE: <br /> ,IIIwCITY/ZIP :$TOL-1-TIDt-4 BUILDING PERMIT M bz�i:I,04-70 <br /> OWNERNAME Tuwy- Lei-.IFESISI ADDRESS <br /> CITY2IP --/I PHONE NUMBER �/�� <br /> CONTRACTOR 11111 IAiD -t SFIDRT =NC. ADDRESS 15ASo DEQ. 11"966 V-D• <br /> CITV/ZIP LD6 g5NO PHONE NUMBER :1%9-/JJ1Z <br /> 6GEOGRAPHICAL INFORMATION: COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ <br /> IN NEW INSTALLATION Ii RESIDENCE NUMBER OF BEDROOMS: <br /> L' TAIR/ADDITION ❑ COMMERCIAL <br /> �CI`,STRUCTION ❑ OTHER NUMBER OF EMPLOYEES: �- <br /> ❑ ENGBJEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': CLAY PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> )I SEPTIC TANK TYPE/MFG Cx)w—%Wti I ?4,L CAPACITYjUC^ qui) #OFCOMPARTMENTS Z <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY #OF COMPARTMENTS <br /> 4'❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �I LEACH LINE #OF LINES:_�LENGTH OF LINES: 40" DISTANCETONEARLST: WELL 10 0'+ FOUNDATION 1 O PROPERTY LINE-70L <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DLSTANCE TO NEARLtt: WELL FOUNDATION PROPERTY LINE <br /> 1f❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEARUT: WELL FOUNDATION PROPERTY LINE <br /> SEEPACEPITS #_ DIAMETER ? � DEPTH DISTANCE TO NEARLR: WELL i5a! FOUNDATION 20' PROPERTY UNE JO, <br /> R <br /> REBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> LSIGNE!— TITLE: C1p T"4*K- DATE:05/6(olt)Z- <br /> . r C <br /> i I I i c <br /> _ I I <br /> I <br /> - - s A <br /> i <br /> w — - - <br /> PU IC fAl.H; <br /> DEPARTMENT //E NLY cf '%J'� / <br /> APPLICATION ACCEP ED BY: AT (V AREA EMPLOYEEIDM�J(_/_[DISTRICT LOCATION Y <br /> INSPECTED BY: DATE: `✓� PERMITFINAL YESDATE: / INSPECTOR: <br /> COMMENT$: WSJ <br /> B� <br /> PE CODE SC INFOAMOUNT ECKM H RECEIVED DATE PERMDISERVICE REOUESTN INVOICES SEPTIC IDN <br /> REMITTED BY <br /> 2 l 37sU L834 /bz S�10 2 <br /> REVISEDn 5-DI _ .._..... .. <br />