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1/: 04) <br />LIQUID WASTE PERMIT <br />SAN JOAQUIN COUTITY "LIC HEALTH SERVICES ENVIRONMENTAL HEALTII DIVISION <br />104 E WESER AVE 3"' FLOOR, STOCKTON. CA 9520212041 46R-3120 <br />7 �7 NON-REFUNDAB E PERMIT EXPIRES I YEAR <br />FROM DATE ISSUED <br />JOB ADDRESS J !/� I Z �D �QJ�--'f�� ' APN <br />CITYIZIP__�'BUILDING PERMIT P _ <br />OWNP.RNAME_kU_}ADDRESS <br />C�(2 <br />PARCEL SIZE: 4146 '! <br />CITY/ZIP <br />PHONE NUMBER <br />i <br />14 <br />CONTRACTOR �4Z V�N�S///+ <br />V L ADDRESS g! <br />CrrvlzIP_ L o ' <br />a- � PHONE NUMBER <br />i � <br />I <br />i <br />GEOGRAPHICAL INFORMATION: COORDINATES X _ V -_ _ <br />TOWNSHJP_____RANGE`—SECTION <br />1 1 <br />TYPE. OF SEPTIC WORK: <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />0 NEW INSTALLATION <br />O RESIDENCE <br />NUMBER OF BEDROOMS: <br />O REPAIRtADDITION <br />❑ COMMERCIAL <br />r �"Als doll r - <br />c pSi:Ft <br />tl <br />NUMBER OF EMPLOYEES: <br />ff <br />I{ <br />r <br />0 DESTRUCTION <br />❑ OTHER <br />I <br />0 ENGINEE'RED�ALTERNATIVE <br />CHARACTER OF SOIL. TO DEPTH OF 3':___ <br />PITISUMP SOIL CHARACTER: <br />_ WATER TABLE DEPTH:— <br />xPERC TESTS) HOW MANY- <br />_ APPLICATION# <br />❑ SEPTIC TANK TYPEiMFG_. <br />- _ CAPACITY <br />#OFCOMPARTMENTS <br />❑ CREASE 'MAP TYPEIMFG <br />CAPACITY__-.. <br />#OFCOMPARTMENTS <br />_ <br />❑ PKGTX PLANT DISTANCETONEAREST: WELL FOUNDATION <br />PROPERTY LINE <br />❑ LIFTSTATION SIZE - -___ <br />TYrEOFPUMP... ___ _ SAND OIL SEPARATOR (ENCLOSED SYSTEM) -_ <br />❑ LEACH LINE iI OF LINES: <br />LENGTH OF LINES: wnmA TO NR—IsT: WELL <br />FOUNDATION PROPERTY LINE <br />INFLITRATOR CHAMBERS: <br />❑ FILTER BED WIDTH <br />LF'N(7rN DFPTN_ DWrAACT TO NEARTJT: WELL <br />FOUNDATION PROPERTY LINE <br />10 <br />O <br />❑ MOUNDED WIDTH <br />❑ SUMPS wnrrH,__ <br />LLNOTH DFP'rH__ bLVTANCETONEAARCr: WELL <br />LZNGTH OFPTH POTANRTONCARRRr: WELL <br />FOUNDATION PROPERTY LINE_ <br />FOUNDATION PROPERTY ONE <br />❑ DISPOSAL PONDS WIDTH-._ <br />LENGTH DEPTII__ , DI&TANCATONRARM: WELL <br />FOUNDATION PROPERTY LINE <br />❑ SEEPAGE PITS #__ <br />DIAMETERDEPTH DI:iTA✓iCE TONRAREJIT: WELL <br />FOUNDATION PROPERTY LINE _- <br />1 HEREBY CERTIFYTHAT 1 HAVE PREPARED THIS APPLICATION ANO THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCE& STATE LAWS <br />AND RULES AND RP.GULAYION3 OF SAN JOAQUI14 COUNTY_ <br />MINIMUM 6K)"ADVAN/E t4OTICE REQUIRED POR INSPECTIONS - <br />PLEASE CALL JM) 468-3423 <br />I <br />i <br />14 <br />1 I I <br />1 A- <br />f <br />i � <br />I <br />i <br />1 1 <br />: <br />Vey -t <br />- t� <br />r �"Als doll r - <br />c pSi:Ft <br />tl <br />I <br />I i <br />'�''j <br />ff <br />I{ <br />r <br />I <br />uErAIETIwsN nE.T <br />APPLICATION A Y' • DATE' Q AREA�1 EMPLOYEE ID/. Q STRICT LOCATION! <br />INSPECTED BY;-/ / _ _ DATL444rd;�__PERMITF1NALy'YES DATE. N� 1NRPE(--TDR: <br />.4 'GXY7jCF+ L'-w-�/ 7'— /rd4l->EQr /11G i "P.E�yI CCs , <br />PEC'JOE SCI FO AMOUNTC'HECKA RECEIVED DATF. PE0.MrtRlTRVICE qf-W1E3TE INVII SEPTIC We <br />REMITTED BY <br />22� 2 1971/0L5&03..25-?? <br />