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PAs. iO2 00 7 LIQUID WASTE PERMIT <br /> SAN IN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 104 E.WEBER AVE 3"D FLOOR,STOCKTON,CA 95202(209)46R-3420 <br /> NON--REFIj/ABLE PRMIT EXPIRES„.I YEAR FROM DATE <br /> ISSUED <br /> cvi /1cEAPN '25-7—?.10- 0 <br /> 2 <br /> - PARCELSIZE:JOBADDRESSRC / p^ <br /> CITY/ZIP BUILDING PERMIT <br /> OWNER NAME y• p^yl <br /> O <br /> r{4(f ADDRESS "�/` l Vl' �J" �✓ <br /> CITY/ZIP `1(./�1J�� 1 f (, PHONE NUMBER :)c(f ) L'��`/�/ �• <br /> CONTRACTOR Oft � �J• Ii1���Y'I��Gd�( � I'Sf���� ADDRESS i `-�G r,�eC�✓•I 6, <br /> CITY/ZIP l_c d I P 1� �) (� PHONE.NUMBER <br /> GEOGRAPHICAL 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 /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> O ENGINEERED/ALTERNATIVE <br /> I CHARACTER OF SOIL TO DEPTH OF 3': - PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ( _ PERCTEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS_ <br /> ❑ GREASETRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Cl LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ SILTER BED WIDTH LENGTH DEPTH DISTANCETONEAREST; WELL FOUNDATION PROPERTY LINE <br /> I r � <br /> ❑ MOUNDED WIDTH LENGTH DEPTH oISTAncE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> I. <br /> Cl DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEAREST; WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFYTHAT I HAVE PREPAREDTHIS 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 /> MI IM 24 HOUR-ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468.3423 <br /> SIGNED: (",n DATE: J^I <br /> LLE <W a� IVED <br /> v I py <br /> E""NT+e•w IbfAT V w•"oyrw �tP1M1 <br /> x WW1 [ <br /> 'z v 5F 9 W piiFPl <br /> _ o Un uN S q I U1�C EA 1Z N,IDN <br /> �I v p <br /> GP <br /> m <br /> - r <br /> i <br /> DEPARTMENT SF. NLY <br /> `I r <br /> APPLICATION ACCEPTED BY:. � '• / '��'_C - DATE: I T AREA `1 EMPLOYEE IDpDISTRILT<J y LOCATION i— <br /> INSPECTEDBY: DATE: . PERMITFINALO YESDATE:. INSPECTOR: <br /> COMMENTS: ',:p• <br /> PECODE SC INFO AMOUNTCHECKN ASH RECEIVED DATE PERMITISERVICE REQUESTS. INVOICES SEPTIC ION <br /> REMITTED BY <br /> 29S-7t/ <br /> REVrsEDE•ISAI - / <br />