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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)469-3420 <br /> NON.REFlINpfBLE PERMIT EXPIRES <br /> /I�YEAR FROM <br /> gDATE <br /> �ISSUED <br /> / <br /> JOB ADDRESS / /✓ / 7 ✓tet �3'+i APN ` -_ (_ � .2 L" � PARCEL SIZE: <br /> _ <br /> CITY/ZIP [.�G�l�-�- BUILDING PERMIT# 6 a o l l ? 7 <br /> OWNER NAME Zffle6L ADDRESS <br /> CITY/ZIP PHONE NUMBER <br /> /A1 7� s7 ilk <br /> r CONTRACTOR /v im_ ADDRES (e CJA <br /> CITY/ZIP PHONE NUMBER 7y7- 7-;t7(? <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> _TY OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> EW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> - <br /> LI DESTRUCTION THER /7O?5G f 109aA <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3':,k�(�ft' IT/SUMP SOIL CHARACTER: A WATER TABLE DEPTH:�f <br /> ❑ PERC TEST(S) HOW MANY / APPLICATION# <br /> SEPTIC TANK TYPE/MFG�/JrC CAPACITY 12L3 C7 #OF COMPARTMENTS <br /> _ ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS t\* <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL�_''#- FOUNDATION- PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINE #OF LINES: a LENGTH OF LINES: ..STANCE TO NEAREST: WELL FOUNDATION 2-J PROPERTY LINE <br /> INFLITRATOR CHAMBERS: I ►�; <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE I' <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE r <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> �f f <br /> SEEPAGE PITS # 191?1 DIAMETER 7 DEPTH G�� DISTANCE TO NEAREST: WELL/00 FOUNDATION�t PROPERTY LINE <br /> I HEREBY CERTIFY THAT I 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 /> MI M 2 HO A V TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 J/ <br /> SIGNED: TITLE: DATE: <br /> ! I <br /> ! ! ! <br /> i <br /> ' i <br /> I <br /> i < <br /> 1 <br /> : <br /> �_�_. <br /> I <br /> ....._....._ <br /> ' <br /> a <br /> .: __i_....i — -- — — _. I _ _..... _. __ -- --— — -- <br /> } <br /> i.. � <br /> 1 <br /> ' 1 i <br /> — <br /> d `_ <br /> _l <br /> t i <br /> t <br /> i <br /> ......._...i _!..... i ...r ! L_ �.�.t_._i .._ _._ i_... ... _.. 1 ... _.._a ... <br /> I.... . <br /> ! i <br /> A.6 _ <br /> Ii 4 <br /> t <br /> i <br /> I <br /> , ; <br /> , <br /> ! p <br /> i <br /> ! <br /> i � � 1 <br /> f <br /> I <br /> i <br /> : <br /> I '� <br />