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LIQUID WASTE PERM"' <br /> %,,oOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEHEALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(2 09)469-3420 <br /> /��/ }LSI `I I_ 2 NON-REFUNDABLE PERM T EXPIRES I InAg ST DA" ISSUED <br /> JOB ADDRESS-A -1 �l W J �, �tll"•'fes- jl' /V�l l�.•� [�j� PARCEL SIZE: <br /> CITY/ZIP /��..CR�•L � I/ A �/ BUILDING PERMIT ###�rO I(51 Z`T I S0 f <br /> P^ <br /> OWNERNAME 1 y� 1,Q,_ U-7 /\ L I .A/II 5'r/,T 9ADDRESS y �• �o��� <br /> CITY/ZIP �( � ,.} �7 �/�V/y�� l�T J lF N�NU--/--BCE��� �]/ / <br /> CONTRACTOR P/ Y/ `�' 'G /• "" ` ADDRESS 1�- (/(``Ck /�li�t��:(C�6jt <br /> CITY/ZIP PHONE NUMBER / k/ v Y( / <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE /SECTION <br /> TYP•,OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> EW INSTALLATION *aSIDENCE NUMBER OF BEDROOMS: <br /> /❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: 01 PIT/SUMP SOIL CHARACTER:(/s?v. S�tK WATER TABLE DEPTH: <br /> ,,,❑ PERCTEST(S) HOW MANY <br /> /i APPLICATION# <br /> SEPTIC TANK TYPE/MFGC� 47W' CAPACITY (�7 � #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> / T <br /> ❑ PKGT%PWNT DISTANCE TO NEAREST: WELL L2 � FOUNDATION IO PROPERTY LINE C L <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i IF <br /> LEACH LINE #OF LINES: ` LENGTHOFLINES: qo MWANCE TO NFAREST: WELLAf FOUNDATION PROPERTY LINE!s�; f <br /> I RS� <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DIEFANCETONEARCR: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DINIANCETONEAREAT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DIREANCETONEAREAT: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIREANCETONEARUT: WELL FOUNDATION PROPERTY LINE <br /> 1 <br /> /1b SEEPAGE PITS # oiAMFTi DEPTH_ DISTANCETONEAREET: WELL FOUNDATION tQ / PROPERTY LINE 79 4 <br /> 1HEREBY CERTIFYTH ILIN <br /> 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 /> .I 21 ADVA CE NOTIC Ui FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE: DATE:�Z'IV d I ` . <br /> 17 <br /> V <br /> �. � . r <br /> el <br /> UMAIL <br /> , w <br /> I . <br /> . C <br /> VI ON 1FNT 1 ' F� T <br /> fl— _ 1 f <br /> 9 <br /> I <br /> �� -j-fi r I <br /> r - "x <br /> ��� <br />