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+ter LIQUID WASTE PERvvA ?34b� C-10 t <br /> SAN JOAQUIN COUNTY PUBLIC.HEALTH SERVICES ENWRONMENTAI,HEALTH DIVISION <br /> 304 L•,WEBER AVE 3�"FLOOR,STOCKTON.CA 45202(2091469-3420 <br /> r �( <br /> JOB ADDRESS NON-REFUNDABLE PERMIT EXPIRES I)'EAR FROM DATE ISSUED <br /> � �qJ "� C !'� ���}-�� APN PARCEL SIZE: <br /> y��f� I/Jy Z BUILDING PERMIT M <br /> OWNER NAME �' +��/I�t.� +'��f�� ADDRESS <br /> CITYILIPi - PHONE NUMBEEjRR �- <br /> CONTRACTOR KIi c.; 4} r- ADDRESS-ZLi � S <br /> L� <br /> CITYILIP _ �.� ._ PIIONF; NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: x TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE <br /> NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMHEROI�EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY 2 APPLICATION N PA _p2QQ ?a <br /> ❑ SEPTIC TANK TYPE/MFG- CAPACITY NOF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY N OF COMPARTMENTS <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: wrLL. FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP - SAND OIL,SEPARATOR(ENCLOSED SYSTEM)_ <br /> Ll LEACH LINE N OF LINES: LENGTH OF LINES: DISTANCE TONFAREST: WELL FOUNDATION �f <br /> PROPERTY LINE <br /> lNFLIT'RATOR CHAMBERS: <br /> C7 FILTER 8ED WIDTH LENGTH DEPTH DN'TANCF.TO NEAREST: WELL, FOUNDATION— PROPERTY LINE <br /> /// <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEARF•ST: WELL FOIINI)ATION PROPERTY LINE �} <br /> ❑ SUMPS WIDTH LENGTH UEPTII DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE k <br /> L) DISPOSAL PONDS WIDTH LL'NGTII DEPTH _ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS N DIAMETER DEPTH DISTANCE TO NEARF-ST: WILL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND Till.WORK WILT,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 NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> <13 <br /> SIGNED; <br /> TI'T'LE: r ttS DATE: 2- � <br /> _.- <br /> I <br /> , <br /> I I <br /> _....._.1- 76...._ <br /> i , <br /> f <br /> 1 { r <br /> rn <br /> I <br /> I <br /> ' I <br /> -71 <br /> 1~ <br /> C :I <br /> , <br /> I j <br />