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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR.STOCKTON,CA 95202(209)46R-3420 <br /> NO [DATE ISSU�E'D( r <br /> ]ADDRESS I ' I�, +.U I� �. !l� 1' k M • APN 013- 0 5 0 - I 1 PARCEL SIZE: Yj' 5'4 <br /> `Y/7JP ( �.. /✓ �I $UILg1yC�R6R�IT M <br /> T C 1` y / ( p � �IYI�� •�1 1 t 6 <br /> I 1 ,OWNER NAME SI.._�r• �' Il I� �.J t CJ• LS._,�� l.'. \�,� ADDRESS 1 �� / -� 1.�� (I��_ 1 I i ( 1''•'. . <br /> 'Y/ZIP '�l.F-1,4.. `✓ �� PHONE NUMBER`• 9 CO <br /> 1 <br /> InNTRACTOR L�'`,)�. l� I. r -�i lJ: ',.,)C.) I C U ADDRESS <br /> PHONE NUMBER <br /> y;OGRAPHICAL INFORMATION: COORDINATES:X Y -_ TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> REPAIR/ADDITION ❑ COMMERCIAL <br /> IM DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> IARACTER OF SOIL TO DEPTH OF 31: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTIC TANK TYPE/MFG_ CAPACITY #OFCOMPARTMENTS --' <br /> GREASE TRAP TYPEIMFG CAPACITY #OFCOMPARTMENTS <br /> bw 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: LENGTH OF LINES: DISTANCE TO NEARi WELL FOUNDATION PROPERTY LINE <br /> I♦ INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DEATANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1w SUMPS WIDTH LENGTH DEPTH DPWANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH" DISTANCETONEARIQc: WELL FOUNDATION PROPERTY LINE <br /> SEEPAGE PITS # DIAMETER DEPTH DISTANCETO NEARIAT: WELL FOUNDATION PROPERTY LINE -� <br /> THEREBY 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 <br /> /NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> :;NE D:1, /Q� 1�-�..�./�- / �(, l�t ,C�fCG`- IlI(Sll. TITLE: /4�. f.(, T - DATE: <br /> —f <br /> T <br /> I - Ili � � ,L• 7 c - I, <br /> I I C <br /> - - - o , --- <br /> —i <br /> do,illed"out <br /> Tr <br /> NEN L FAL H D VISI N <br /> I <br /> i I <br /> 1 DEPARTMENT USE ONLY <br /> PLICATION ACCEPTED BY:�"r"^ �-r^` _- DATE.-1-1 -0 1-AREA EMPLOYEE IDM bqg DISTRICT LOCATION, <br /> I"T.'SPECTED BY: DATE: PERMIT FINAL❑ YES DATE: INSPECTOR: <br /> '-MMENTS: <br /> PE CODE SC INFO AMOUNT E ,CASH RECEIVED DATE PERMITSERVICE REQUESTM INVOICEM SEPTIC IDM <br /> REMITTED BY <br /> �1ZZ 521 A� ,[oi a� �a` (�fl�30 co 50 <br /> REVSED LI WI <br />