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LIQUID WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br />304 E, WEBER AVE 3"' FLOOR, STOCKTON, CA 95202 (209) 46M-3420 <br />NON-REFUNDABLF PERMIT EXPIRES I YEAR FRO41 DATE KSUED <br />JOB ADDRESS S113 Main - -. APN 9 - OO r 0�- PARCEL SIZE: q' _ <br />CITU'/ZIP _ j o c� n BUILDING PERMIT n <br />OWNER NAME �""1�J 1 \Vllr'� 1 ADDRFSS�J 'Y7 IV DttiLqdo �Y <br />-. <br />CITY/ZIP I'1L Qh _ .. _ PHONE NUMBER�C <br />CONTRACTOR�r �lA)1JQr — — ---- ADDRESS <br />CITY/ZIP PHONE NUMBER <br />GFOGRAPHICAL INFORMATION: COORDINATES: x Y TOWNSHIP RANGE: SECTION <br />1 <br />TYPE: OF SEPTIC (YORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br />❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br />❑ REPAIR ADDITION ❑ COMMERCIAL <br />U�Y OkJj.11Pt(�XE�S <br />DESTRUCTION ❑ OTHER -- —_- ( '"F; <br />Ll xENGINEERED ALTERNATIVE. a IT LX <br />R 1\7,11� <br />i i( <br />CHARACTER OF SOIL TO DEPTH OF 3': <br />❑ PERC TF_ST IS) <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ PKGTX PLANT <br />_PIT/SUMPSOILCHARACTER:,V11, ell -lit may h�ttn iM1ll � t: <br />9 <br />HOW' MANY APPLICATION # vvul ur, I jy I ul IIP Ul�4i C�+r,�I�SP}�i.lL <br />TYPEMFG _ CAPACITY (?y VIIor#bFCOk1P�i wWfsoIt,'1.:Aon <br />TYPE.MFG C4ACITY # OF COMPARTMF,NTS <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />❑ LIFT STATION SIZE. TYPE OF PUMP SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINE #OF LINES: _ LENGTH OF LINES: DISTANCE TO NEARER: WELL FOUNDATION_ <br />INFLITRATOR CHAMBERS: <br />❑ FILTER BED WIDTH LENGTH DEPTH _ DIRANCETONEARFS-r: WELL FOUNDATION_ <br />PROPERTY LINE <br />PROPERTY (.INF. <br />❑ MOUNDED <br />WIDTH LENGTH <br />DEPTH DISTANCE TO NEARER: WELL FOUNDATION PROPERTY LINE <br />❑ SUMPS <br />WIDTH LENGTH <br />DEPTH D1RAN('ETONE.ARL%T: WELL FOUNDATION PROPERTY LINE_ <br />( <br />C <br />❑ DISPOSAL PONDS <br />WIDTH _ LENGTH <br />_ DEPTH _ DIRANCETONEARE_ST! WELL FOUNDATION PROPERTYLINE <br />- <br />❑ SEEPAGE PITS <br /># DI.AMET ER <br />---- <br />DEPTH DIRANCETONEARER: WELL FOUNDATION PROPERTY UNE <br />^ <br />1 HEREBYCERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAW'S <br />AND RULES AND RECITATIONS OF SAN JOAQU IN COUNTY. <br />I.%R;Nl 24 HOUR A�NCE <br />NOTICE REQUIRED FOR INSPECTIONS -- PLEASE CALL (209) 468-3423 <br />1 <br />'11 <br />, <br />7 <br />— <br />v <br />SIGNED: /�'�G`^"` <br />�- V ! t-�l[� <br />/L/ TITLE. L Z/ )Ute n DATE: <br />- <br />-- —+--I—I <br />t -r <br />P <br />--- - - - <br />1 <br />- - <br />1 <br />'11 <br />, <br />7 <br />T i <br />