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LIQUID WASTE PERMIT SAN JL,..,JIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMENTAL HL,LTH DIVISION 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(209)46K-3420 NON-REFUNDABLE:PERMITEXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS__-- v `G� APN (/ZD'- n PAR('F:I,SI/.F::�G 1'i'Tlq CITY/-ZIP _ �I _ _ BUILDING PERMIT p O R I-7 Q 7 OWNER NAM E��q �C_ Q�_V_ \- V ADDRESS CITY/ZIP _ PHONE NUMBER CONTRACTOR ,/ v I`'CJZ - ADDRESS ��__-_ ®O ( '�0CA CITY/ZIP PHONE NUMBER (( -( ' 4 -_ - GEOGRAPHICAL INFORMATION: COORDINATES: X_ Y TOWNSHIP_ //t—RANGE SECTION TYP OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: J ❑ REPAIR/ADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: Cl DESTRUCTION' Ll OTHER - ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': v PIT/SUMP SOIL CHARACTER: i24Y 1. ❑ PERC TEST(S) HOW MANY �+ APPLICATION# Cr SEPTIC TANK TYPE/MFG eisC' 7�+% -+ CAPACITY (Z S #OF COMPARTMENTS ❑ CREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS ❑ PKCTX PLANT DISTANCE TO NEAREST: WELLr "±' FOUNDATIONS_ PROPERTY LINE 00 ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM)____ I� LEACH LINE #OF LINES: NGTH OF LINES`'�1�` DISTANCE roNEAREST: WELL�� f FOUNDATION Id I PROPERTY LINCf( � / INFLI HAMBERS: _ ❑ FILTER BED WIDTH LENGTH DEPTI4 DISTANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE C ❑ MOUNDED ,• WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTHLENGTH DEPTH DI.STANCETONEAREST: WELL FOUNDATION PROPERTY LINE w , I r � I ( 'v SEEPAGE PITS # bIAMETER_� DEPTH DISTANCE TO NEAREST: WELL FOUNDATION /ZJ 'f PROPERTY LINE �� , I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE:I,A WS C AND RULES AND REGULATIO�NSSAN JOAQUIN COUNTY. MIN MUM 24 HOUR A E NOTI QUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 SIGNED: TITLE: DATE: ! { I- -i-......I.......�-- -- - ( - ..-..I........................._............_......_..........--.+......._..i......._........... _........_._ ........ .....I........._.._._.....1................._...-,-.._...i.._.._.._.._... ! ........ ............1.. .........._�._ .. ......_._ ......_........ ........�....... ....... ......�._ ... .. .._ ; ..i 1 r C' ....f... - —�._.._r...........�...... i....... - - _ _ .__--4--. i .... ' .. _. i i _... _. _..._......_.__....._ _._..... .._.................. -- --- - __....__.. ....._ . ._: �......... . - - - - ....:...... t {- .._.. ._..........._._.. _ _----- ..._....._. ........_4... ................. ._........_..._.... :_... _. .._..._......_........._._.........._.�......... ....... ..................... 1__ . 1 ... .. ---- .. -.... ......_...........:_.......... _ ...i.......... ................ i '1�. � ' � ( 1. .... .....�. ..__._'. __�._.._. _._......... ,,... ...._ ........-- �. .... , ......_.. .._....... ._ I a 1 I t _...__..._...... _ _......_._ __.._-1.__......_. t._......... . _ _ . -_�__ _ 1 i I ��.. . I.X }� - i I .fi-- i - _...�......_...j_ ._....._ ( - -- -.. : i � r . _......_............._-. .........___ ....._._.._:..__......_._._ ....... ......_. ......_. .......... ..- --._ .. .. _.... ... _ .. _ ._..._.. ...........___ __ _ ____ _...._ .. __.__ ._ _ _ . �..... -.-.- ...._..........................-.._ i i._... .. ............-_ ....... _._.... .._._..�_..... ......_.._._....1....... ----_....._...____ .. ___ ........... _ _... __...1._._..........._:-....._..................__.........._I......-....I.......................................................................:........_..._................_....-................. ...........................................:......... .... I I i i F i . .F_._ .....I-_........._....._._.._ .. ... .. .. .. a. .. _ � � i I I i I ' , i I i .....(........_L...........'.._1\ ....`:C):at3.t•`•1.,,t!`.:�r{-..... .............I_._ j..... I I....... I �, �;. �.._ r I I _ �.�_.f_....�....._ i .t .-F-_ __.-.._........y.._y.__.._.__.�_. i... .1........... ...__j_._..i-.._.._I `__.- - __.-�._..._t._.........._.._ .. _...._........_...._..........__........___. .. .. - I + i DEPARTMENT USE `.Y APPLICATION ACCEPTED BY: r DATE: AREA �I EMPLOYEE IDN DIST I LOCATION -A 2 � INSPECTED BY: �'�/�o rr�( �/Y DATE: Vy' O� PERMIT FINALG YES DATE. INSPECTOR: COMMENTS:/ / ��rN�✓ /O 7LGt�/ d-"5 IfI�C- Li!q� -S-oZ OWtwfl �PCLVS'r ?RK PL CODE SC INFO AMOUNT CHECK ASH RECEivtb DATE PERMIT/SERVICE REQUEST# INVOICE# SEPTIC IDM REMITTED I91' ` 4113 l i7 :32� qI �� z 3. a ��od3� �8� EVISED M•I."I - ---- --