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1cl- _ COD LIQUID WASTE PERY-T 30 JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMI _HEALTH DIVISION 304 E.WEBER AVE 3RIFLOOR,STOCKTON,CA 95202(1D9)468-3420 NON-BILI NDAB E PERMIT EXPIRES 1 YEAR DATE I$ISUEU 2-31 JOB ADDRESS APN y/,� lJ�ll/J� PARCEL SIZE: J PC CITY/ZIP_ ` ► / BUILDING PERMIT# OWNERNAME Ir �.� II ADDRESS CITY/ZIP Y L /` 0 PHONE NUMBER CONTRACTOR tj- t V. VIU ADDRESS CITY/ZIP to a1 oil PHONE NUMBER9,�__ 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: 13 DESTRUCTION L3OTHER O ENGINEERED/ALTERNATIVE r G CHARACTER OF SOIL TO DEPTH OF 3% PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: PERC TEST(S) HOW MANY_( APPLICATION# P I 1 —Q 01, —'(511 ❑ SEPTIC TANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS L ❑ 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: DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: ❑ FILTER BED WIDTH LENGTH DEPTH DISI'ANCETONEARE.SI': WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: 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 1 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. %I Iry M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-P�L�EEASE CAcLL(209)468-3423 SIGNED: �� 1 .-. �, TITLE:/-C��D��'J� DA" PG: �� (5 . 2— ..... • JJJ..L1�lJJ.JJJ_1JJJ JJJ JJJ JJJ . J IJ_IJ3J_ . � � .1JJJ.J_IJJ.IJJ J J.1 J.. .: 1•...' _... ��..✓J/ JJ,IJJJ.IJJJ JJJJJJJ,1JJ. y_b iP i ..._ _...._�..._... jJJ JJJJJ�/ J,�11JJJ J,1J,/J 1J JJ •- '� )JJJJJJJ_J_J.J J_IJ.JfJiJJJJJJ�JJJ ;4;_ •-'�' f JJJJJJ�J_IJJJ_IJJJJJJJJJJJ.IJ + i JJ 4 • (JJJJJJJJJ j jJJJ�JJ JJJ J.LIJ - ... 1 IJJ� -2 JA J JJJ JJJ JJJ _...._ JJJ JJ )JJJJJJ J JJJJJ i JJJ J JJJJ.111 1JJJJJJJJ JJJJO ' 1 JJJJJJJJJJ_Aliy.�L-i�j ,r -�1 � ...... 1 J-1_I_IJJJ_I IJIIJJ J-JJ_I_1J J.JJJJ.IJJ. Ij(• "'3 - � 1-JJ_I_LLJJJJJJJ JJJJJJ JJJ J •r:4:,�Y i 1 r J JJJJJJJ�JJJJJJJJJJJJJ� .JJJ JJJ_IJyJ1JJJJ.IJJJ l JJ .�))11 Y _........,._.._ 6 JJJJJJJJJJJJ,,I1JJ _L_IJ_I JJJ IJ JJ.1JJIJJJ JJJJjJ 1r` � �ROAD lr LIJJ.IJJJ J_IJ.J�J fil JJJJJJJJJJJJJJJJJ -• iJ ,J YWJJ)JJJJJJJJJ JJ JJJJJ : • SME\\ CMP SfR , JJJJJJ,JJJJJJJJJJJJ(Olt J `.J _JJJJJJJJJJJJjlt��AJ) JJJ JJJJ..IJ,JJJJJJJJ J •� ~* f • R6•o __..... •. JJJJ JJJ.IJJJJ J �jJJJJJJ / _....... r J J IRIDIYq,p'(p MEA�i:1-.•I .................. 'q 1 ...1 'o c:::?•:r�' ;. .......... ti •, C�JSTlfC Nem L1V DuxroorJ Ina R RFE ' -- _., �. ACMt 0010 SPALVK , W 6L QM SGSjD r. W7f�N': _ .......... 'A YEAR"Q I oA ex•AYAu cum 74xr� 6298 on DEPARTMENT USE ONLY APPLICATION ACC EDB : --DATE: i • C U AREA 1 I EMPL('� j9tt'� D�pIySTRICT�LOCATION_�_1 INSPECTED BY: liC DATE: PERMIT FINAL❑ YESDATE: �I CQj 'aINS� ., COMMENTS: Mt O � ISL lU_IfYF �� •(� �a IT I OUNT\' .�$_ -AN tTlA.. (lI p IRS PE CODE SC INFO AMOUNT CHECK .ASH RECEIVED DATE PERMIT/SERVICE REQUESTN INVOICEM SEPTIC ID# REMITTED BY 412-1 sal �� Zz:l& << aI 0 580031 °►8z REVISED U-15.01