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LIQUID WASTE PERMIT <br /> SAN JOAQIIIN COL-N7Y PLISLIC HEAIA H SERVICES EN VIRONMFNTAI.HFALTH DIVISION <br /> 304E WESERAVE3"FL.(%1R.STOCKTON,CA 952(1?(2091 i6R-3410 <br /> JOB ADDRESS .�1��J NON-REPIINDARI.E➢F:RM17 F.XA,.. I Y6F�.AR FAO'DATE FSS�:'E�D PARCEL SIZE,D,3 4' <br /> CITYIZIP-- l v�-�F—�CT�.1 - _ BUILDING PERMIT V r(J !/!r —!TL - <br /> OWVF.R NAMELQC�4-7 -_,_. ADDRESS 3`�ato �F"•1 �• <br /> C.ITYIZIP_- - �F}�T,a,,�'��1 -�, }•.0 C--.L,r { _/+ PHONE NUMBER <br /> CONTIIACTO, ` <br /> R—' �•._�*_+CF�•� 7k S�TC�-� lw ADDRESS <br /> LSiGSJ�(►4/ i�P7Yy�..7(� T'-'✓J <br /> (:I'1•Y7ZIP � -D{ F'T7�0 PHONE NUMBER —2 55 <br /> GEOGRAPHICAL INFORMATION: CCIORDINATLS-x Y l'OWNSHIP RANGT._ SECTION <br /> TYPE OF SRPTIC WORK: INSTALLATION WILL SF.RVF,; NUMBER OF LIVING UNITS:�_ <br /> ❑ NEW INSTALLATION E( RESIDENCE NUMBER OF BEDROOMS: <br /> 44 RGPAIR'ADDITION ❑ COMMERCIAL <br /> Cl DESTRUCTION O OTHER NUMBER OFEMPWYEtS: — I� <br /> ❑ ENGINEERLIYALTERNATIVF. <br /> CHARACTER OF SOIL TO DEPTH OF 3':_ _PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST 01 HOW MANY APPLICATION <br /> ❑ SEPTICTANK TYPE/MFGCAPACITY JOFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPOMFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGT%PLANT DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIrr STATION SIZE11'PE OF PL.MP SAND OILSEPARATOR(ENCLOSED SYSTEM) <br /> ! ! 0 <br /> LEACH LINE #OF LINES: I LFNGTII OF LINL';;:� oL'TANCE TO NEAREci: WELL-504 FOUNDATION �! DAOPh'KTY LINE Z0 <br /> INFLITRATOR CHAMHERS: <br /> ❑ FILTER BFA WIDTH LX%GTH_ DEPTH 0—w.1O.S.KrAT: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENUTH DEPTHDI:STANCETONEAH—: WELL FOUNDATION PKOPERTY Ll'—E__ <br /> ❑ SUMPS WIDTH__ IF.NGTN DEPTHDISTANCETPNEARIST: WELL FOUNDATION__ PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH__ t.F.NGTH DEPTII_ DISTANC.TO NEAREST: WELL FOUNDATION PROPER'T'Y LINK <br /> SF.EPACf.PITS p I DIAMLTE0.340" DEPTHZ%7 0-1—rn NEARFar: WELL TOO+ FOUNDATION 7� PROPERTY LINE t� <br /> HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BL DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> V AND RULES AND REGULATIONS OF SAN'JOAQUIN COUNTY. <br /> y <br /> 'MINIMUM24HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468.3423 <br /> ,L TITLE: CF�'y.JT T�� '� DATE: <br /> ' <br /> i ......... <br /> '3 <br /> • <br /> F , <br /> I + <br /> : <br /> R <br /> r ---- OCT- <br /> _. :.... . .. ........ <br /> ly...... <br /> Ppl�18LIC HEALT � <br /> 1. t.. <br /> 1-- -7 <br /> ' NEALT D atON <br /> ... <br /> DEPAI <br /> RTMEN'T'11 USE NLY <br /> APPLICATION'ACC c OMT:. �v^�T��RLA E1aPLUYEE IDI ��/ o15TRl I.00A(101 ! <br /> INSYK'IEU _ _„_ DATE: IO/ PERMIT FINA4 YES DATE:_INCPECT OR <br /> PE FODE SC INFO AMOUNT Ecu. SM Rl:!'F.]\'FII DATF PFRMIT�SFRVICF RFOI:F.5T4 INVOICE/ SEf^,IC IN <br /> REMITTED LLY <br /> i <br /> 6v(SEDL. --- <br />