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LIQUID WASTE PERMIT SAAwO#QUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTA` .Fli DIVISION /y r 304 E.WEBER AVE 3RD FLOOR,STOCKTON,CA 95202(209)4(,R-3420 2-2-l (� NON-REFUNDABLE PERMIT EXPES 1 YEAR FRO DATF.1,SUED JOB ADDRESSISg _ /T/�/�f iB/�J �`r� �-� AZ�tG N� APN•I• / 2 �� 2- PARCEL SIZE: (!�. FsZ CITY/ZIP Z'v ' ' BUILDING PERMIT# OWNER NAME / 0 ADDRESS t CITY/ZIP - PHONE NUMBER / CONTRACTOR F-:L1�L..�/�I�Q/�„L.�;�,/L ADDRESS `lK7-5— f' ),'^P2-77Z-),'^P2-77Z-j CITY/ZIP S T7Ln1 — /-(J - 8 - i 3 Y; PHONE NUMBER p\V'� GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP—RANGE—SECT ION INN)) TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: ❑ NEW INSTALLATION ❑ RESIDENCE -� NUMBER OF BEDROOMS: ❑ REPAIR/ADDITION ❑ COMMERCIAL J ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: ❑ ENGINEERED/ALTERNATIVE �CHARACTER OF SOIL TO DEPTH OF 31: c PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: 10l PERCTEST(S) HOW MANY- 7 APPLICATION#' Z---,! 7 4=7 5? (®� SEPTIC TANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS ice, ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS (� ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE " INFLITRATOR CHAMBERS: T� ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN CCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS AND RULES AND REGULATION F J QUIN COUNTY. Z4 R ADVANCE N IN ECTIONS-PLEASE CALL(209)468-3423 rJ SIGNED: , TITLE: ti'G-//(/i5 DATE: 1. :...__._ :............. i..... 1_ a._... t.. y . _...... ....._... .. a......_... 3'� s t _.............................. 1. _. a r1p I f i Rp��F E SITE \/ I _ - t- N�P� - --— C= _..... _., _.. G -- - _.. s�P S ............... sat�MrZ-f)t�+ �I .>:�rLtt_+�Ea ICE sm�- ff �� P� �.......... ..... ... .... 1. y �� oZa�+luNt �ni .... ISI,,I ....�'6 - 1............... . ,�, ,.. _.._._.... _.._ ...__- .--._.................. ......... _..-.._.-....... _...- -......._.__..._.. �. ..-...... ...._.. 1 ( --.....t........y>..................t........_..�... . DEPARTMENT USf.ONI Y APPLICATION ACCEPTED __DATE: �� :�f/-//�� 1tEAMPLOYEE IDx /ST LOCATION 1 "- 7 INSPECTED BY: DATE: �(1PERMIT FINAL YES DATE: - SPECTOR: i- _ COMMENTS:/&-7 r� l C)"-'!�**AJ Aa I - 0•00 / I 3 '71sw 3 o nr 0,20 1 d,r� lCrr PE CODE SC INFO AMOUNT CHECKx .ASH RECEIVED DATE ERMITiSERVICE REQUESTN INVOICEN SEPTIC ION• A(C REMITTED BY Z X22 .�2� � I IS�-7 7_;� t �c: of - �'�3 3•� A."I ----- --