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LIQUID WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH OIVISION <br />304E. WEBER AVE IND FLOOR, STOCKTON, CA 9M2(209)469-3420 <br />NVN-R FUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISE <br />JOBADDRESS / � �L`[,� j ��i/ f/ AP.N/)�.}�'rr bh71.r PARCEL SIZE. <br />CITY/2iP0G BUILDINGPERMITH <br />0WNER NANTE_ X41,4 %W�') ADDRESS 5 �O �A%� <br />CTTY)ZI P_ _! PHONE ""'R1.� <br />SC 'NFO <br />CONTRACT" <br />PERMITr ERV1 'QLF.ST4 INVOICE. SEPTR: IDM <br />11% <br />CITYlZIP%O <br />rrS <br />_,} PHONE. <br />GEOGRAPHICAL INFORMATION: COORDINATES: x -._ Y _4TOWNSHIP _RANGL-__ SECi70N <br />TYPE OF SEPTIC WORK: INSTALLATION WILL SERV& NUMBER OF LIVING UNITS:_ <br />U NEW INSTALLATION x RESIDENCE <br />NUMBER OF BEDROOMS: I ,/ <br />XREPAIR/ADDITION ❑ COMMERCIAL <br />NUMBER OF E14 PLOYEES: <br />❑ DESTRUCTION ❑ OTHER <br />U ENGINFEREDlALTERNATIVF. <br />CHARACTER OF SOIL TO DEPTH OF 3':._ PITISUMP SOIL CHARACTER: ,i _ __WATER TABLE DEPTH: <br />❑ PERCTEST(S) HOW MANY APPLICATION# .__. <br />1 <br />SEPTICTANK TYPE/MFG �f• �/ CAPACI'T'Y 0 OF COMPARTMENTS_ ,_ <br />❑ GREASE IRAP TYPFJMFG CAPACITY 40FCOMPARTMENTS <br />❑ PKGTX PLANT DISTANCE TON FARM: WELL_ FOUNDATION PROPERTY LINE <br />❑ LIFTSTATION SIZE TYPE OF POMP SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />J� ! <br />LEACH LINE 4 OF LINES. _1 _LENGTH OF LINES: (.+ oISTANCR......4AT: WELL DLL FOLINDATIOh'__Y,6 4,, PROPERTY LINE�j <br />INFLITRATOR CHAMBERS: <br />❑ FILTER BED WIDTH LENOTH DEPTJI__ DI.-ANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br />❑ MOUNDED WIDTH_ _ LENGTH DEPTH-, DIFFANCE TO HE kU-%T: WELL FOUNDATION PROPERTY LINE <br />❑ SUMPS WIDTH_ _ LENGTH DEPTH _ _ _ DISTANCE TO NEARIMT: WELL _ FOUNDATION PROPERTY LINE <br />�r <br />v <br />❑ OISPOSAL PONDS WIDTH LENGTH` DEPTH_ ffiv NCYTOSRAIII T; WELL— FOUNDATION PROPERTY LINE_` <br />_ <br />q I <br />SEEPAGE PITS IF DIAMETP.R DEPTH-Gy� "KTANCETONEARaFr. WELL FO14WUNDATION lF PROPERTY LINE�1� <br />1 HEREBY CERTIFY TIIAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN C/O�UNTY ORDINANCES, STATE LAWS <br />AND RULES AND REGULA. TIONS OF SAN JOAQUIN COUNTY. <br />/ MINIMUM 24 HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209) 4681423 <br />SIGNED: TITLE:_-DATE:�� <br />I <br />APPLICATION ACCF.PI <br />_ I i <br />pf�PARI'MEN'F CO <br />➢ATE. AREA/41EMPLOYEE IDPD16TR1 LOCATION <br />F: �/- /I/CI PERMIT FINAI.);.T',' YES DATE: 6fINSPECTO — <br />�'�-llC��JI.2nuG �..�J1.�l�.ls1 <br />PE I.00E <br />SC 'NFO <br />AMOUNT- EC'KAI ASH RECEIVED nATL <br />REMITTED BY <br />PERMITr ERV1 'QLF.ST4 INVOICE. SEPTR: IDM <br />2{ <br />rrS <br />03�1a <br />