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LIQUID WASTE PERM16 S. JAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENIWEALTH DIVISION 304 E.WEBER AVE 3N°FLOOR,STOCKTON,CA 95202(209)469-3420 NON-REF('ND,\RLE PERMITEXPIRES I 1 FAR FROM DATE ISSUED(J JOB ADDRESS U S �C (�s:�C,-J Q,� APN �3C'1 ( O_1a+ . PARCEL SIZE: CITY/ZIP �rz CA �� -`J37 �+ BUILDING PERM II H OWNERNAME LT 111 -TyL'Ja\ Lrev MMS ADDRESS 0'A-00 - �•l:�l��r VZ VCNJ 1L A b CITY/ZIP S��C.NLT>�'N► I CR-- �i S3, Vrl -- PHONE NUMBER `'A-� �" �3 CONTRACTOR oyQ-4wC ADDRESS CITY/ZIP PHONE NUMBER LAS O- C)3 GEOGRAPHICAL INFORMATION: COORDINAILS X_______ _Y TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: REPAIR/ADDfTION COMMERCIAft ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: _ ❑ ENGINEERED/AL.TERNATIVF CHARACTER OF SOIL TO DEPTH OI;3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: ❑ PERCTEST(S) FIOW MANY APPLICATION4_ ❑ SEPTICTANK TYPE/MFG— CAPACITY #OF COMPARTMENTS rJ ❑ GREASETRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS W ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ LIFr STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) Cl LEACH LINE #OF LINES: -2- LENGTH OF LINES: 100 oiSTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: \^ LIFIL rER RFD WIDTH LENGTH DEPTH DISTANCETONEARLST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE Q ❑ 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 DISTANCETONEARFST: WELL FOUNDATION PROPERTY LINE d 1 HEREBY CERTIFY TIIAT 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. ti NIININI J24 HOUR_ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL(209)468-1423 SIGNED: \`/ TITLE: DATF,: ` I � .........._...............I I �..._. - _. _._ _... .._ _ ...... . _..-......; ...... ._...-. f O _ _ .} --- .�_...... .. I I 1 I F d � : _ ___....._..I.........._. L._. _L_ L..._. I . I --L- - 4— ._...__... I I ........ . ._..._...__........_.._...L.._._... -.......... .._....__. ... ......... _ _._...._..._......._..._.. !._....._..._. -� _�..... _ _........_......._._.......... ._. }_... -- - -( -- ........... .... ........ ........__....._..... ....._ ._._. ...._......_........._..__� ............_...... I } - - _.. ...._1..................._. _. ...._..... _.�.. _.._. _.. ... .. -- I -._ ... .. I.......--� - - _-�- _..........1 �. _.. `... _ �....c... !!-- ..ECS ..T:�._..�. ..._ .._......I-- _..._...__..{_..._�_.........._...._._.__.....�...... _-_._. .........r.__...._._..........._. ........._ _._._}.._._..._......_......:..............__.. _.. _... �............ _ N......_........ k _._.... i _...__.L._.-. _.__...._._._ k_.....-_ _...........__-. - a-...._.._ . SA�JCAOt)IN COL NT) . ........... ...... s ru r i I DEPARTMENT USE ONLY APPLICATION ACCEPTED BY: V -`ti�� _ DATE: AREA �)" EMPLOYEE IDN_1 J _DISTRICT LOCATIONS INSPECTED BY: �- c DATE: V PERMIT FINALIa/yES DAT —1/ .�NSPECTORL` �� C COMMENTS: PE CODE SC INFO AMOUNT HEC ASH RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# SEPTIC IDN REMITTED By -11 40 REVISED&15.01