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o-0602-91S <br /> ��DDD 2s�� LIQUID WASTE PERMIT <br /> 1J SAN IOAQU304 OUNTY PUj3LIC E.WEBER AVEI HEALTH FLOORSSTOCKTON.CA 95202 ERVICES E(209 )468-.34TAL 20 DIVISION c-7 <br /> ^D <br /> LIS NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED +� �Y <br /> JOB ADDRESS '�;Z 7(2-?- (l %//// APN 2 N3y D"'D PARCEL SIZE: <br /> CITYIZIP. �/l/�C=(JrC/1 BUILDING PERMITN �J <br /> OWNER NAME_ / ICGADDRESS _� � �IjU� I�l <br /> CITY/7.IP /4/>//�C G/T -._._-_ PHONE NUMBER7 '7-�-/aQA In <br /> CONTRACTOR of Oe ADDRESS 1-5; zzyaz2 - <br /> CITY2IP ��A,�Tc Gam¢ �/7- PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATLS:X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> )C NEW INSTALLATION 'j{ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> - <br /> Ll PERC TEST(S) HOW MANY (�J APPLICATION N <br /> yl, SEPTIC TANK TYPEIMFG 7 L./ CAPACITY NOF COMPARTMENTS— <br /> '❑` GREASE TRAP TYPE/MFG CAPACITY NOF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP , SAND OIL SEPARATOR(ENCLOSED SYSTEM) +1— <br /> IK LEACH LINE NOF LINES: LENGTH OF LINES:JrD DIaTANC[TO NEAREST: WELL FOUNDATIONZI PROPERTY LINE/ <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAR&": WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH OLRANCIETONEARERT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DIATANCETONEARUT: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LEN(TfH DEPTH DLSTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS N DIAMETER DEPTH DIRTANCETONEARLTT: WELL FOUNDATION PROPERTY LINE <br /> W <br /> I HEREBY CERTIFY THAT 1 HAVE.PREPARED THIS 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. /V <br /> NJ]NIMUM 24 HOUR ANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)468-3423 <br /> SIGNED: J�� ,�.(� TITLE: �(�... .!r DATE: <br /> E- <br /> 114 <br /> - <br /> ' <br /> -- - <br /> r_ 114.1 h <br /> PU LIC EA fri R <br /> aHU WIF <br /> f <br /> JW 1 <br /> 1 I _ <br /> yl/ — G <br /> DEPARTMENT U ,P' <br /> APPLICATION ACCEPTED BY: DATE: O AREA�Z��(J EMPLOYEE IDY�DISTRICT�LOCATION� <br /> INSPECTED BY; - - _ OATL�PERMITFINALQ YESDATE: INSPECTOR. <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT ECKN.ASH RECEIVED DATE PERMIT/SERVICE REQUEST* INVOICEN SEPTIC IW <br /> REMITTED Y <br /> JO 326"'N.LW LW IS o zBI D.S <br /> REVISED*-I."t <br />