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1"t i LIQUID WASTE PERMIT <br /> SAN JOAQUINCOUNTY PUBLIC�ALTHSERVICESENVIRONMENTALHEALTHDIVISION SEPTIC <br /> E.WEBER AVE 3'FLOOR.STOCKTON.CA 95202(209)AM-3420 <br /> `�q NON.REFU NDABLE PERMIT EXPIRES I YEAR <br /> �FROM <br /> DATE ISSUED Z �//J� <br /> , <br /> JP JOSADDREsk APN� `� - PARCEL SIZE:^ (� <br /> CITY/ZIPJn BUILDING PERMITN <br /> ' .A OWNER NAME t){C�+L'f� !r� ADDRESS <br /> CITY/ZIP J�6G �1, �J L� PHONE NUMBER q7t`*2. 1 <br /> I <br /> CONTRACTOR ADDRESS <br /> Ciri'f71P ____ _ PHONE NUMBER i I P <br /> GEOGRAPHICAL INFORMATION:COORDINATES'.)X_ Y _ TQw 4SSHIP RANGE <br /> S�.tip RVT w1# n1}11�1 <br /> i INSTALLATION WILL SERVE: 11�}��( jQF �.. ��`e{,1 <br /> j TYPE OF SEPTIC WORK: Work i1C1)11,�Ise 2 / <br /> �❑ NEW INSTALLATION ❑ RESIDENCE { U_MBE O ED <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL r 4}ivlrlr)C'rf�cQ <br /> NUMBER OF EMPLOYEES' <br /> ❑ DESTRUCTIONS OTHER �Mwec�rp.` <br /> {f ❑ ENGINEERL-D!ALTERNATIVE I <br /> f CHARACTER OF SOIL TO DEPTH OF 31:_-.� PITISUMP SOIL CHARACTER WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY APPLICATION# <br /> Cl SEPTICTAIYK TYPE/MFG- CAPACITY #OF COMPARTMENTS <br /> ❑-gAE:ASE TRAP TYPE/MFG - CAPACITY #OF COMPARTMENTS <br /> O' 8 <br /> ❑ 7PKCTX PLANT DISTANC E TO NEAREST:: WELL FOUNDATION PROPERTY LINE <br /> ❑ I`TIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ 0,EACH LINE #OF LINES: LENGTH OF LINES: msrANCETONEARTST: wEI.L FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS! <br /> ❑ YFR.TEA BED WIDTH LENGTH11- DEPTHOIRPANCETONEAREST: WELL FOUNDATION PROPERTY LINE Q <br /> } ❑J MOUNDED WIDTH LENGD[ DEPTH P=ANCETONEARWr; WELL FOUNDATION PROPERTY LINE <br /> { ❑ SUMPS WIDTH LENCfHI DEPTH w.%TANCETONE.ARM: WELL FOUNDATION PROPERTY UNE <br /> 7 ❑ DISPOSAL PONDS WIDTH LENGTI DEPTH vlSTlvCETONGRrATi WELL FOUNOATION PROPERTYUNE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DL NCRTONGRXM. WELL, FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> 1. <br /> �j AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. f,�l <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)4 3423 1 <br /> !-S <br /> ^ ICNF:D: N TITLE: b LAYS -DATE: Z O <br /> f1l1 1 <br /> —} <br /> i.,ICEIN(E <br /> �__ <br /> - <br /> - <br /> TY0 <br /> 7 <br /> . l - <br /> -- ,. Ir.n07 <br /> 1 <br /> ,,,DEPARTMENT USE NI.Y <br /> %-yj(-/C`7n��rL <br /> APPLICATIONACCEPTED BY, GATE: AREA J�l�� ! �EMPLOYEE IDM ice- _DISTRICE LOCATION <br /> I ' <br /> INSPECTED BY. - I DATE: PERMIT FINAL❑ YES DATE: INSPECTOR: <br /> 1 COMM NTS: ! 1^1 r^� G� <br /> 4 5 2. e.L <br /> / PEC SC;NFO AMOUNT CHECK RECEIVED DATE PERMRSERVN:E RE f I.WOICFJ SE 1011 <br /> 1 I 0.EMST(ED BY <br /> R£K.EO <br /> r k _. <br />