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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUALIC HEALTH SERVICES ENVIRONMENTAL HEAL7 ION <br /> 1 T 304 E.WEBER AVE 3"D FLOOR,STOCKTON,CA'952Q2(209)468-3420 <br /> JOBADDRESS{� '"1-t tom,1 t. � FUND ABL_ P E APN ES C AR 7I ODATE/ISSUED /. 7? <br /> . 'y^.�. f� _rr� � �� PARCEL SIZE: <br /> CITYIZIP �(����.w �I/ � � BUILDMC PERMIT 0 (j'(' (7 <br /> OWNER NAME bawl N A Pa A V&HDRESS {., ]C7-1 \ �7 S1 ZT a tj <br /> CITYIZIP PHONE NUMBER <br /> CQNTRACTOR��L l.ri�1l�OI 4 IIS t"�7�Y . ADDRESS <br /> CITY/ZIP �' PHONE NUMBER' <br /> i <br /> GEOGRAPHICA.0 INFOR.NIATION: COORDINATES:X Y TOWNSHIP `RANGE SECTION <br /> TYPE OF SEPTIC YORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ .NEW INSTALLATTION O RESIDENCE NUMBER OF BEDROOMS: <br /> (3 REPAIR'ADDETWN O COMMERCIAL <br /> p. --. - NUMBER OF EMPLOYEES: I <br /> ❑ DESTRUCCII ., O OTHfiR, <br /> O ENGINEEREb!ALTFRNATIVE <br /> CHARACTERQPSOIL TODEPTHOF3': - PIT/SUMP SOIL <br /> CHARACTER: <br /> WATER TABLE DEPTH: <br /> PERC TES TYS) 'HOW MANY ' APPLICATION# <br /> ❑ SEPTIC'TANK TYPB!MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY #OF COMPARTMENTS <br /> Q PKGTX PLANT DISTANCE TO NEAREST:. WELL FOUNDATION PROPERTY LINE <br /> -❑ LIPTSTATTON SIZE TYPE OF PUMP SAND OIL SEPARATOR,(ENCLOSED SYSTEM) <br /> •❑' LEACH LINE #OF LINES:. .LENGTH OF LINES: � DIETANCI70 NEARpT: WELL� FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: - m <br /> FILTER BED WIDTH LENGTH DEPTH DISTANCITANIARIST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIETANCITONLARIRT: WELL FOUNDATION PROPERTY LINE f <br /> :O SUMPS WIDTH LENGTH DEPTH DIETANCI TONWILAT: WELL FOUNDATION PROPERTY LINE <br /> _ .❑ DISPOSAL PONDS/ WIDTH LENGTH DEPTH DWANCETONLARLST: WELL FOUNDATION PROPERTY LINE ' T <br /> .❑ SEEPAGE PITS # DIAMETER DEPTH WMANCITONIARLAT: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE.DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS N <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ICV <br /> M��INNIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468 3423 <br /> .SIGNED: WMJ��,OI(�/.l�lvy�ly�r�/1 SYI�. TITLE:Im.fG { DATE: <br /> — <br /> _ <br /> _ 8 E ;+3�t,• a �\ <br /> ilk A Grt. g IE G, P <br /> ILL_ d.•' — <br /> KI) <br /> (,.•�f /l/� DEPARTMENT EO LY <br /> APPLICATION ACCEPTED BY:. �""'T�f rJ •�-� '-'— DATE: d V' REA EMPLOYEE IDR S�DISTRICT�LOCATION--�y . <br /> INSPECTED BY: - DATE: 'PERMITFINAL7 YESDATE: INSPECTOR: <br /> COMMENTS: 3 <br /> PECODE SC INFO AMOUNT CHECKS ASH RECEIVED 'DATE PERMITAERVICE REQUESTS INVOICES 7, SEPTIC IDA <br /> REMITTED By <br /> Zzz �t9 iiSto �. G b o S12.CO3I/ 7Z <br /> t , <br /> REV ED ISAI I'' <br />