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APR <br />NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />141 /- 1•30 — <br />CITY/ZIP BUILDING PERMIT # <br /> TOWNSHIP RANGE SECTION__ GEOGRAPHICAL INFORMATION: COORDINATES: X <br />INSTALLATION WILL SERVE: <br />411, RESIDENCE <br />COMMERCIAL <br />OTHER <br />/FYPE OF SEPTIC WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />DESTRUCTION <br />ENGINEERED/ALTERNATIVE <br />NUMBER OF LIVING UNITS: / <br />NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />Z <br />WELLAC2 FOUNDATION "67 PROPERTY LINE__ <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /># OF LINES: LENGTH OF LINES; <br />INFLITRATOR CHAMBERS: <br />WIDTHJ.11_ LENGTH 37 DEPTH _3 5151690510 NEAREST: <br />WIDTH LENGTH DEPTH <br />SUMPS WIDTH LENGTH DEPTH <br />CI DISPOSAL PONDS WIDTH LENOMI DEPTH <br />SEEPAGE PITS S DIAMETER DEPTH DISTANCE TONEARP-ST, <br />LIQUID WASTE PERMIT <br />SAN JOAQUIN COUNTY P(JELIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br />304 E. WEBER AVE FLOOR.. STOCKTON, CA 95202 (209) 469.:1420 <br />JOB ADDRESS -7,fifo PARCEL SIZE: 0 P I <br />ADDRESS OWNER NAME <br />CITY/ZIP PHONE NUMBER <br />CONTRACTOR 6 le IR. ,y4/1(.4, V ADDRESS <br />r <br />7 V2 7— 3 Sis <br />/4-jo iC:e-",1-/ Ht_ <br />— c/ PHONE NUMBER CITY/ZIP <br />CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br />PERC TEST (S). HOW MANY APPLICATION <br />Qg <br />Cr) <br />(.4-3 <br />SEPTIC TANK TYPE/MFG CAPACITY # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY H OE COMPARTMENTS <br />CI PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />LIFT STATION SIZE TYPE OP PUMP SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />CI LEACH LINE <br />a FILTER BED <br />CI MOUNDED <br />berrAncs TOPIEARESTI WELL FOUNDATION PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED Tins 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 />/ /MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CAL 1...(209) 468-3423 <br />l, 5- <br />- L MINIM , 7r, , 1119ripMMOMEMmirac„ , 1,- , <br />. link <br />-16 <br />WM <br />IIIMM <br />. .-- <br />NM wr • II .1111 I" t : , 1 or I <br />P- <br />1 <br />-I, <br />111.-117' <br />. <br />9 . II iiii; la ' im. ..... • . gii. , i —I _ Ell. L.. _ , , , <br />-,--i /yr , <br />..., <br />_ _ _... — <br />:ij - 4 <br />_. <br />7 <br />.:' <br />Efiti <br />1 <br />Fi'6E 4091 <br />_ <br />_ <br />- <br />. <br />--....- <br />. . <br />- <br />- -- <br />_. <br />.,.._ —...... <br />- ChIWION <br />DISTANCE TO EAAEST: WELL FOUNDATION PROPERTY LINE <br />DESTANCITDNEARTmT, WELL FOUNDATION PROPERTY LINE <br />WELL FOUNDATION PROPERTY LINE <br />SIGNED: <br />0(A_AIL04"., <br />DEPARTMENT USE ONLY <br />DATE: I - (0-71 AREA 21q EMPLOYEE it:453(36 DISTRICT 3 w3cArios g ri <br /> <br />DA I I; f 2- IS -de PERMIT FINAL YES bATE INSPECTOR: <br />APPLICATION ACrEPTED BY <br />INSPECTED BY: <br />COMMEND: <br />, <br />to/ rhc 34 - 44 4-4 Room aseb 44,./41 614 /f ig" V 6.4"° <br />PECOM ' EC INFO AMOUNTC.C...5114 <br />REMITTED <br />;LEH RECEIVED <br />EY <br />DATE PERMITPEERVICERMIEM INVOICE*_ SEPTIC IDE <br />4 1 I 0 1 ic 180 I0r3-1 -e,..t. Pk:Av..: SA0032 11-1 <br />REVIEW S-M4i <br />TITLE: ,7 DATE: ./ 2 I /Y Jo L.