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�� Sp 21 D LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 104 F WEBER AVE 3u) FLOOR, STOCKTON, CA 95202 (209) 468-3420 nn AA N NON-REFUNDABLE. PERMIT EXPIRES I �R ROM DATE ISSUED JOB ADDRE0 SS �� 1S✓ I Ul.l� �� _ APN ��-��_ CITYILIP_ Acte47 et J5 --CJ BUILDING PERMIT OWNER NAME_ VOL ADDRESS PARCLI. SIZE; ! ` CITYr"P _- -_ ,-_ PHONE NUMBER_ AMOUNT' CHFC ' SH REMITTED RECEIVED BY CONTRACTOR Ae l/lll ^t 5 � a tcs -u> ADDRESS l 2co : ZZ! CI ] YIZIP �� Z V rC �t PHONE NUJIRF:R - 7- Z- __:�<0 I GEOGRAPHICAL INFORMATION: COORDINATES: x V _'TOWNSHIP_ R.ANGC SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:� ❑ NEW INSTALLATION Nf- RESIDENCE NUMBER OF BEDROOMS: 6L REPAIR/ADDITION ❑ COMMERCIAL ❑ DESTRUCTION ❑ OTHCK NUMBER OF ENIPLOYF.F.S: ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 31:_ PIT/SUMP SOIL CHARACTER: WATER TABLE DF,PTH: O PERCTFST(S) HOW MANY APPLICATION # ❑ SEPTIC TANK TYPF/MFG_ �kl c0n' l CAPACITY It -too NOF COMPARTMENTS_ ❑ GREASETRAP TYPElMFG _ CAPACITY #OFCOMPARTMENTS ❑ PKGTX PLANT DISTANCE TO NEAREST_ WELL FOUNDATION PROPERTY LINE ❑ LIFT STATION SIZE _ TYK OF PUMP SAND OII. SEPARATOR (ENCLOSED SYSTEM) # OF LINES: LENGTH OF LINES r J LF,ACH LINE _L MWANCETONF.ARCS-F; INFLITRATOR CHAMBERS: x 3 3 �- WF'I.L�i- FOUNDATION z% PROPERTY LINP ❑ FILTER BED WIDTH LENGTH DEPTH_ DLCTANCETONEARLV: WFLI. FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH_` DISTANC'ETONEAUF-M WELL. FOUNDAI"ION PROPERTY LINE, i� Q SUMPS WIDTTI LE.N61H DEPTH DISTANCE TO N[AR&ST: WELL FOUNDATION PROPERTY LINE \� ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTA,NCF rONEARLST: WELL FOUNDATION_ PROPERTY LINE, 0 E. SEEPAGPITS # r DIAMET'ER DEPTH D1STAr{CF rOnuRFLT: f.+ WELL 1CX7't FOVNDAI"ION PROPERTY -C�L LINE 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY' ORDINANCF_S, STATE LAWS AND RULLS AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209)468-3423 SIGNED: c -tir�� ` TITLE: DATE: \ ' I E APPLICATION INSPECTED BY i • a -4 _.I-- _. - - ----- � _..... ..... _ 1 _.i.__ 1.. _�_..{_ .. _�. _._.*__ _ �- _i....•,•.._y..._-.._....t. ..�.._..I.-_!_-_'•'--"i-._,' � �h\C30iP1_U_�;1N y_..F._y..�....;_... T- ---- --- ----�.....T._...�_..,. _• -'t'--- _ _ .S. ..F�.�.-_-`--_ _ _i_....� i t 1 .7i --_L_._ ,—__+ ... I 1 . --' ... _j_ ..i—_i�_.' F .-1-•- I--�-...�.. _; _ .I 1 -----, - - 1 / y DEP TMENTUSEONLY 1410 � _DATE: REA MPLOYGE IDq STRICT_ LOCATION -4 / ._ .. DATE. / L DT/ PFRMI-f FINAL YES DATE PE CODE SC 1NP0 AMOUNT' CHFC ' SH REMITTED RECEIVED BY DATE PCRMII/SERVICE RE iUESTN INVOICEA SCPTIC IDM a tcs a a-7 l 2co : ZZ!