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LIQUID WASTE PERMIT <br />SAN JOA011IN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br />304 E WEBER AVE 310 FI..00R, STOCKTON, CA 95203 1 7 09) 46R-3420 <br />' j/NON-REFUNDABLE PERMIT EXPIRES 1 Y'ETE - UED <br />JOB AEORESS (' S, + T�.(_G [ _ APNPARCEL S17.E: <br />CITY!?.IP___. BUILDING PERMIT %__ c'"11 <br />OWNER NAME_ D _ ADDRESS <br />CITYI7JP��, f� i' (� Li•�.....�!!RONE NUMBER_l�F-_{ <br />CONTRACTOR !`7117 A% 7 5ADDRES.S <br />CITYILIPZfJ",�L� / PHONE NUMBER <br />GEOGRAPHICAL INFORMATION: COORDINATES: X„__.___._______ <br />PERC TEST (SI <br />_- Y,____ <br />TOWNSHIP _RANGE SECTION <br />TYIE OF SEPTIC WORK: <br />INSTALLATION WILL, SERVE: <br />NUMBER OF LIVING. UNITS: <br />NEW INSTALLATION <br />V <br />RESIDENCE <br />l� <br />CAPACITY MOF COMPARTMENTS_-- <br />D <br />PKGTX PLANT <br />NUMBER OF BEDROOMS: <br />❑ REPAIR/ADDITION <br />❑ <br />COMMERCIAL <br />—1 - -- <br />C3 DESTRUCTION <br />O <br />OTHER _ <br />T <br />NUMBER OF EMPLOYEES: <br />❑ ENGINEERED/ALTERNATIVE <br />AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br />INFLIT'RATOR CHAMBERS: <br />CHARACTER OF SOIL TO DEPTH OF 3': 5 <br />24 UR ADVANCE N TICE REQUIRED FOR INSPECTIONS- PLEA^ E CALL j209) 4683433 <br />PIT/SUMP SOIL CHARACTER: <br />_ WATER TABLE DEPTH:�S, <br />❑ <br />PERC TEST (SI <br />HOW MANYAPPLICATION# <br />LENGTH DEPTH DFcrANCFTONEARTST: WELL FOUNDATION PROPERTYLINE <br />,❑,/ <br />Yf <br />SEPTIC TANK <br />TYPF)MFG_,�ppT�CAPACITY <br />1a 7f� 110FCOMPARTMENTS L� _- <br />D <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY MOF COMPARTMENTS_-- <br />D <br />PKGTX PLANT <br />DISTANCE TO NEAREST: WELL-� <br />1..NDAnDN�_ PROPPRTYLINE �+ Z) <br />L3LIFTSTATION <br />SEEPAGE PITS <br />SIZE _—, Tvr¢OF PUMP <br />- SAND OIL. SEPARATOR (ENCLOSED SYSTEM) <br />I HEREBY CERTIPY THAT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS <br />LEACH LINE <br />MOF LINES: LENGTH OF LINES: <br />DISTANCE TO NEAR ETr; WELL 1Q0 FOUNDATION 1P PRWFRT'Y LINE <br />AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br />INFLIT'RATOR CHAMBERS: <br />MLN1 <br />❑ <br />FILTER BED <br />WIDTH <br />LENGTH DEPTH DFcrANCFTONEARTST: WELL FOUNDATION PROPERTYLINE <br />❑ <br />MOUNDED <br />WIDTH <br />LENGTH DEPTH bISTANCETONEARRAT: WELL FOUNDATION PROPERTY LINE <br />❑ <br />SUMPS <br />WIDTH <br />LENGTH DEPTH__- oMAWS Ta xEARE.w: WELL FOUNDATION__ PRDPFATY LINE__, <br />❑ <br />DISPOSAL PONDS <br />WIDTH <br />LENGTH DEPTH DIWANCSTONEMW: WELL FOUNDATION PROPERTY LINE <br />❑ <br />SEEPAGE PITS <br />M <br />DIAMETE0. DEPTH DUTwCETONr .Irr: WELL FOUNDATION PROPERTY LINE <br />I HEREBY CERTIPY THAT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS <br />AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br />MLN1 <br />24 UR ADVANCE N TICE REQUIRED FOR INSPECTIONS- PLEA^ E CALL j209) 4683433 <br />SIGNED: <br />TITLE: 4kje %/« 1 DATE: �!. ' -f 2 p <br />DEPARTMENT USE ONLY <br />APPLICATION <br />INSPECTEDBY:_ _ DATE: �/� PERMR FINALB'YES <br />COMMENTS: - <br />i •T--_�.._-r-_ <br />ION �DISTRICTLOCA710N_ /_ / <br />