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� LIQUID WASTE PEW"T Lbud,- -4.) cv `O I .,N JOAQUIN COUNTY PU)3LIC HEALTH SERVICES ENVIRON, .L HEALTH DIVISION 304 E.WEBER AVE 3N'FLOOR,STOCKTON,CA 95202 1,u9)468-3420 N-REFU� `' NDABLF.PERMIT Vf EXPIRES I YEAR FROM DATE IISSUEDPARCEL SIZE: C l� JOB ADDRESS kY l n W APN L4) / ��!!�J CITY/ZIP UV-�P�n- `�•� �[� lT/ BUILDING PERMIT# OWNER NAME � '^- I�� DRESS 3V Ct La JT ter 'LG W CITY/ZIP ` �V,*/ • ' PHONE NUMBER CONTRACTOR Mt t 10,19Mevsp v-\f Asq--x-sXyxI t ADDRESS &4cw--N 4c "`' CITY/ZIP loco PHONE NUMBER GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: ❑ REPAIR/ADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: ❑ DESTRUCTION ❑ OTHER ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: �* PERC TEST(S) HOW MANY APPLICATION# SCJ limos ❑ SEPTIC TANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ( - ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. /�� MINAIMUM 24."OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 _/� SIGNED: I 11� y ltt Dl I �.1^I r 1�hl/ .SQL/[ TITLE: G \ DATE: ^C v �, i , _ I i ............. !........................ _ .. . ...... .......i .... . I , __ ............. ......... ._.. ... .. ........... ..........1..........................f....... . _ ........... _ .fi ......._.i.......... ..... . — �,o9u4 " \ _................................_.... .... .......... .................. ..... ............ ..........._...I...................._....:•-""..... :`< �.' 1 I I i V iY Q \ l�y•� ... ....'....... .. I::::::::: I ...................... Wa . ..r............. .. .. ........ tJ 1. ............ .........._ rQ _......_...._.. .U �_... >� i.. .D-.094-0-.4Z N N1 y\ ..t �•••••••••••• P. A-.9L .0-.S ^`� , .. '" .. ........-.i...................-..........._...........i............. I C ji�#-. '«..,..:•� r I j i' v: �. i.._._ W .:ryY ... e i ,xts a\ I..............._ I I o n „ ............ ... .. ............! . . _.......... n �....... V f S I Y. _ I-.._.......... j._..........t............ ...........i.............�....._..........._............ {---... � ,S,_,�— '�;�`•f.' Via® m� \, .... I I •w��, o � � e s t N` .. �§ M ........... ..............................I.............}......... W $ �� n € .... ...........t-......._I.............�............i......... �; >� T................. I R� 4 Rs "\!� .IF• Ru ! V .. .. .. .. ... .. 3v�u]rBOn O4u59p �,firt ^ _ ...•1.....•.. I .Y.. J • 3' F y I i4a }.......... ............L................__..�..............._. pu,..,;{r h .A.. .• (h "�Y=<<fif'S :. : i ...........' I........ .................. / .a] 4 �............�...... __ .. .....i.......... ' z A-AL .0-AF .9-A9 ........................................... ....................._..........., a .... .. .. __._ i..... I. _............'._...... i 1.........._._..... ....... ._.....-.__._._...._. ........�..........._......,.............._.._.......(..._....................�.._......-'----..................._......................................,.............._......_.... ; 1 I ! DEPARTMENT F,O LY APPLICATION ACCEPTkD BY: "Z� �I/ '�� '`-- DATE: ,AREA EMPLOYEE ID# DISTRICT LOCATION INSPECTED BY: - ! DATE U� PERMIT FINALYES DATE�G! INSPECTOR: INSPECTED BY��COMMENTS: W� l � n JO Kr IJ ?z -0-24, 144V 7`-' 114 /I PE CODE SC INFO AMOUNT CHECK# ASH RECEIVED DATE PERMIT/SERVICE REQUESTO INVOICE# SEPTIC ID# REMITTED BY REVISED R-I5-01