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GEOGRAPHICAL INFORMATION: COORDINATES: X_ V TOWNSHIP RANGE SECTION <br />A DDRESS_____„7,7„za ekte,....04.A.../ .4 it,/ <br />PIIONE NUMBER <br />CONTRACTOR <br />4-105Z-4,‘ CITY/ZIP <br />NUMBER OF LIVING UNITS: <br />NUMBER OF BEDROOMS; <br />414111r* . NUMBER OF EMPLOYEES: <br />LiFr STATION SIZE TYPE or Pom <br /># OF LINES: / LENGTH OF LINES: qt., <br />INFLITRATOR CHAMBERS: <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />jop" Ad/ ( <br />FOUNDATION ,f PROPERTY iINS DISTMK. TO NEAREST: SELL 51/LEACH LINE <br />FILTER BED WIDTH LENGTH DEPTH DISTANCE TO PIC A RIM: WELL FOUNDATION PROPERTY LINE <br />MOUNDED WIDTH LENGTH DEPTH DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br />SUMPS WIDTH LENGTH DEPIH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />L3 QISPOSAL PONDS WIDTH LENGTH DEPTH Dm/ANEW TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />t, p.N( <br />SEEPAGE PITS 11-01 <br />/ <br />: DIAMETER 1.• 011111P•_) DISTANCE To NEAREST: WELL/0 ( FOUNDATIONI.:01 ( PROPERTY LINE <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 />ASH RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />/ <br />. 3 <br />MINIMUM 24 HO E NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209) 468-3423 <br />TITLE. DATE: SIGNED: <br />I ! 1 <br />„--- <br />f <br />- <br />LIQUID WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br />304 E. WFFIER AVE FLOOR, STOCKTON, CA 95202 (209) 46/4•342C <br />JOB ADDRES.92-WY P-12 <br />N('-REP BASILE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />APS - 2:10 - 01- <br />• <br />crrvizir /fe,A9-"Z/2r;" BUILDING PERMIT # <br />OWNER NAME ..N9 01:‘,A,4111. ADDRESS <br />CITY/ZIP •04e.4‘kr PHONE NUMBER <br />PARCEL SIZE& ()C <br /> <br />TYPE OP SEPTIC WORK; <br />VE W INSTALLATION eREPAIR/ADDITION <br />DESTRUCTION <br />ENG ENEEKED/ALTERNATI VE <br />WATER TABLE DEPTH: <br />INSTALLATION WILL SERVE: <br />LI RESIDENCE <br />C-AtIKI$RCIAL <br />• <br />CHARACTER 01 SOIL TO DEPTH 0F3: <br /> <br />-4kaL,11110_ <br />PIT/S Oki I CHARACTER: <br /> <br />PERC '1057 111 HOW MANY <br /> <br />."..7St APPLICATION* <br />. , <br />----tAt , <br />SEPTIC TANK TYPE/MPG CAPACITY V OF COMPARTMENTS <br />Li CREASE TRAP TYPFJMFG CAPACITY # OF COMPARTMENTS <br />PKGTE PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />t .174 <br />—L- <br />I <br />I• <br />.,.....-- i <br />-1. .. <br />.1E07.- , <br />i ! ''^ 4 . •. ' ' ' ' . ""..-....t". ' . . <br />I I 1 ! • ' : ; ..,,, 312139r <br />1.-"----iji ; • <br />. rsr_ul-- <br />-4- - - ! 04, ---r--- t ' i ' . I i • __E NAROI•AE • i I , ! <br />' 1 ' <br />!ir'it <br />1 . L i 1 / -,, : <br />. . ! ---, ._ <br />APPLICATION A cw4 <br />/ 0.14r.dor/ INSPECTED <br />DEPARTMENT USE ONLY <br /> DATE 1, •- It L EMPLOYEE ID/.'4O4 DISTRICT <br />DATE.043/e•Ve,...Z„PERNIIT FINAL?N YES DATE.ZO INSPEITDR. <br />LOCATION1 <br /> <br />COMMENTS:_ <br /> <br />PE CODE SC INFO AMOUNT <br />REM II-TED <br />CHECKe..../SH RECEIVED DATE PERMIT/SERVICEREI)UESIS INVOICFA SEPTIC ID <br />4:11 ° 115 18o Osii- -LX . i-ISD <br />REV TEED