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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) 440.3420
<br />.REFUND
<br />JOB ADDRESS_ Sa
<br /> IgEr TEXPIRES I YEAR FROM D
<br />1
<br />A7
<br />6
<br />E_ISSUED
<br />AWN coy-03
<br />
<br />PARCEL SI •
<br />re-e
<br />
<br />CITY/ZIP BUILDING PERMIT
<br />OWNER NAME_ ketie( K 442 PI/ 5 ADDRoIS
<br />CITWZIP PHONE NUMBER
<br />CONTRACTDR _
<br />
<br />ADDRESS fle iO4 (2s 3 .
<br />PHONE NUMBER WV-(Cg&X CITY/ZIP
<br />
<br />GEOGRAPHICAL INFORMATION: COORDINATES X TOWNSHIP RANGE SECTION
<br />TYPE OF SEPTIC WORK:
<br />NEW INSTALLATION
<br />EPAIR/ADDITION
<br />DESTRUCTION
<br />ENGINEEREWALTERNATIVE
<br />/..")
<br />INSTALLATION WILL SERVE:
<br />ESIDENCE
<br />COMMERCIAL
<br />OTHER __--.------------
<br />
<br />NUMBER OF LIVING UNITS:
<br />NUMBER OP BEDROOMS:
<br />intIMBEMPLOYEES:
<br />
<br />CHARACTER OF SOH. TO DMV-317- PIT/SUMP SOIL CHARA-CTER: WATER TABLE DE e c,
<br />relic -rEsr (S)
<br />?‹...,SEITIC TA
<br />ZI GREASE P
<br />PICGTX NT
<br />LIFT STA
<br />APPLICATION q
<br />17 LEACH LINE
<br />HOW MAN
<br />TYP FGE72, ....112tr
<br />TYPE/MFG If
<br />DISTANCE TO AREST: WELL
<br />SIZE
<br />TYPE OF (UHF
<br />P OF LINES:
<br />INFUTRATOR CHAMBERS:
<br />CAPIR-gte, 4/ 4 cteent6ENcias-- 10-4e7
<br />4A204wte- XylatbrtenoiSITMENTS
<br />FOUNDATION PROPERTY LINE_
<br />SAND OIL SEPARATOR (ENCLOSED SYSTEM)
<br />bMTANC6 TO NIEARIND WELL FOUNDATION
<br />PROPERTY LINE
<br />FILTER BED WIDTH
<br />MOUNDED
<br />sumps
<br />DISPOSAL PONDS
<br />La SEEPAGE PITS
<br />LENGTH
<br />DEPTH MITANRITDNEMULINI WELL
<br />DEPTH OffrANCE TO P411A1Crr: WELL
<br />CENG DEPTH NMFANCI TO AIRARIND WELL
<br />LENGTH DEPTH DIFFANCR TO NRARRSI: WELL
<br />DIAMETER DEr111 DLTTANCt NEAAEET: WELL
<br />FOUNDATION PROPERTY UNE
<br />FOUNDATION PROPERTY LINE
<br />FOUNDATION PROPERTY LINE
<br />FOUNDATION PROPERTY LINE
<br />FOUNDATION PROPERTY LINE
<br />
<br />WIDTH
<br />
<br />WIDTH
<br />TO
<br />WIDTH LENGTH
<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 or SAN JOAQUIN COUNTY.
<br />MINI DM 24 HOUR ADVANçP46TICE REQUIRED FOR INSPECTIONS - PLEASE CALL 0011461-3423
<br />DATE: tr. -/o -0 Z
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<br />APPLICATION ACCEPT
<br />INSPECTED BY:_
<br />COMMENTS,
<br />DRY "YCL DEPARTMEPE UVIONLY
<br />DATE: LP I r 2 AREA 21 EMPLOYEE too ISM DIsTINCT_LLOCATION31
<br /> 2-* PERMIT FINAL 15 YES DATE: .4 42.4(a." INSP
<br />PE Coot
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<br />- SC INFo AMOUNT
<br />REMITTED
<br />EC.2.1.)4
<br />SY
<br />RECEIVED --DATE MONT/SERVICE REOL/ERT• - INVOICE/ 4R/TIC Or j
<br />4210 H5 1 P 0 ':323
<br />"--
<br />SIGNED: TITLE:
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