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I� LIQUID WASTE PERMY -% jj U1N COUNTY PUj3LIC HEALTH SERVICES ENVIRONMENTAL fL7RLTH DIVISION L 304 E.WEBER AVE 3"°FLOOR,STOCKTON,CA 95202(209)46R-3420 1 1 ` NON-RF UNDABLF.�P/ERMIT EXPIRES 1 YEAR FR%1 �ISSUED JOB ADDRESS ( I 'r/ (O �� y / APN (/G�3 qcqV� /j ,.® {'� '�wt�yq...`�� App A �} PARCF.1,SIZE:__?r CITY/ZIP 40�/l 6 '95-2--yV _ B141.D n � �� (' � ,r ff F �\7n^ ,Q-y��J� OWNER NAME „��e J ,/l f 1 /_ ADDRESS 5/'1�'K.i CITY/ZIP // _ PHONE NUMBER7� n CONTRACTOR '!�-UlL l/V%I� /��._ ADDRESS -z-f -z 5-- CITY/ZIP_J /J `1 � ' S _ PHONE NUMBER Y _ , L� 5— GEOGRAPHICAL INFORMATION: COORDINATES: X Y-_ TOWNSHIP—RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: ❑ RF'PA1R/ADDITION ❑ COMMLRCIAL ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': PIT/SU:NIP SOIL CHARACTER: WATER TABLE DEPTH: 41 PERC TEST(S) I IOW MANY APPLICATION# ❑ SEPTIC TANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS ❑ 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: ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE l J\1 MOUNDED WIDTH LENGTH DEPTH DISTANCFTONEARECT: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREST: 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 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS v AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. -JAI N f� I 1 O( DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 c SIGNED: TITLE: n/G�ti/�� DATE: // U { I.. � . I : : : �._.... . �.......... _ 1.. f IA -._. I......£mm •- .» PARCEL uAP ... f c� jG� .. LOT 12 OF JORY TRACT NO r � ' I :.f•• IN SCC1104 26. T JN.,R 7E.. _. _ _........�_ .�..D EMc. ., .+�Nr_zT uD.a tr u.. Y - .✓C.ti�'�-Cr-rl� - Son Jo"un Counl, -i _... �.._... • • I cmra ma f _ DILLON k 11URPHl' ..... ;......4 f .. Ov / I case l.:c o»rr�Fzas BARS a•tlF mx 17TH lm 13 �� I _uw.. r. ..ww•, rr • I +tlTr.� l4vi: �jjljJ ��X 1 ilW ...... .. _ _ IFCFNaE .� _ P4�L' emru-1 vAxcFa I _,,.,• m!2/ I �E C,^7 �a1�ow a� c. JA Iz --��pq 4 a P aL� HE LTIFT�SFVSRC va. �`-"' FhiY1+'i©NMFAlT�7 k!k#44.IkJ.plU�ilf)N - 1 1 i i , WAV Maxx novo +• ..__. 4__.i....._. 4—__ I DEPARTMENT YSEO ,Y APPLICATION ACCE ED BY: DATE: (/!/�gMp� (',// (�/Jj(�'- AREA-Z� OYEE ID#you�/5'DISTRICT / LOCATION1�`y INSPECTED B -DATE: PERMIT FINAL❑ YES DATE: INSPECTOR: /J� ` IT 19 � 4M TTS:&- pp /� 1f �r��1CS' t !-o 1, -Z7�3 * a `CAV)c�ell 'A v iD /i�iGo'��'}"El_I^• \$ IT_-�Cay'1M)T�S A�'SVC��6\ ��;p Ik�SC'�,._�.1�j�G`S' t�._v�_ PE CODE SC INFO AMOUNT c'HK' CASH RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# SEPTIC IDM REMITTED 22 7-- 0I IC � - �.