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LIQUID WASTE PERMIT <br /> SAN JOAQCIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 104 E WEBER AVE 3""FLOOR,STOCKTON.CA 95202(209)46%-3420 , <br /> �yY NON-REFUNDABLE P.EMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOR ADDRESS x176 0( C LC,,e= � � APN �V-7-3/3 Z 17 PARCEL.SWE: /D /4CA,-' <br /> LLG BCILDING PERMIT <br /> OWNER NAWE_ L �/IP-vL (f,47-1,U _ ADDRESS , L S7-6 y6t;C&L 7eG� <br /> C <br /> CITYRIP c'l•1-JI <br /> •J t _wV-r _ _ .__ PHONE NUMBER�T70 7� <br /> CONTRAC'I'ON �f ADDRESS <br /> CIT1',LP PHONE NUMBER <br /> GEOGRAPHICAL.INFORMATION: CCX)RDINATLS.X V TOWNSHIP RANO[ SECTION - <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL.SERVE: NUMBER OF LIVING UNITS: <br /> pL NEW INSTALLATION A RLiSIDENCE NUMBER OF BEDROOMS: •3 <br /> ❑ REPAIR'ADDrf(ON ❑ COMMERCIAL <br /> Ch DESTRUCTION ❑ OTHER NUMBER OF F.MPLOYEFS: <br /> ❑ F.NOMEERED'ALTERNATIVE <br /> CHARACTER OF SOIL.TO DEPTH OF 3•: PITISUMP SOIL CHARACTER: WATER TABLE:DEP"L'H: <br /> ❑ PERCTEST(S) NOW MANY _ APPLICATION k_ <br /> !f SEPTICTANK TYPEIMFG_____P_L_ CAPACITY l ur�. #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE,MF'G CAPACITY SOFCOMPARTMENTS <br /> ❑ PKGI'K PLANT DISTANCE TO NEAREST: WELL. T•OIJNDATION PROPERTY LME <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> JamJ+ 1 <br /> LEACH LINE kOFLINES: LENGTH OF LINE.^: YCt DIWA.ClTONEAREST: WF,IllyL T FOUNDATION 7` PROPERTYUNEiS"�" <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH I.ENOTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> U MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEARENT; WELL FOUNDATION PROPERTY LINE <br /> -� SUMPS WIDTH_ LENC:TH 126 DEPTH-t� - DISTAN('E1ON6A.—: WELL FOUNDATIONtb4 PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENDTH. DEPTH-__ DLSTANf'GTONEAREST: WELL FOUNDATION__ _ PROPERTY LINE <br /> ❑ SEEPAGE PITS V DIAMLTER DEPTHDIST SNLRTONEARM: WELL FOUNDATION - PROPERTY LINE__ O <br /> I HEREBY CERTIFYTHAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULESAN'D REGU'LA'TIONS OF SAN JOAQIAN COUNTY. <br /> /�MVNIMUVI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> ` SIGNED: -_- _TITLE:- Etc-PSA DATE: !y Z 0 <br /> , <br /> 1 <br /> T <br /> : <br /> i' <br /> -I- <br /> �t. <br /> - - . <br /> .. ..... <br /> .... <br /> ... .......... ..... +. — j <br /> , <br /> , <br /> F <br /> I <br /> 1 I <br /> , <br /> J�d Gi <br /> retie e o <br /> DEPARTMENT SE �/fNI.Y .qsem� ya <br /> APPLICATION ACT'Ill ED _ DATC:� /aL_AREA Z EMPLOYEEIDP-- ` �,DISTR.bT E-LOCATION L <br /> INSPECTED tt DATE: _( r►F.RMIT FINAL M YES DATE__ _ I%3PE�EFOR: <br /> C'UMMF.NIS'_ WLLl,S�L VP�I��u (.{>SZ-• pT SU L�,_ S� _�-.�• ` Rte_.. .— <br /> f <br /> PL('UDT SCINFO AMOUNT NECK/ ASH RECEIVED DATF PERMD SERVICE REOI:ESTV INVOICE, >♦EPPIf IPI <br /> RLMITTLD B1' <br /> 3(2-r lte'i �Z5/61 ADP7: S- <br /> Z�12 <br />