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(0--)- LIQUID WASTE PERMIT SANJ,_ JIN COUNTY PU$LIC HEALTH SERVICES ENVIRONMENTAL ._.cTH DIVISION 304 E.WEBER AVE S""FLOOR,STOCKTON,CA 95202(209)46H•3420 wy. NONREFUND,A�BL/nEE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED. JOB ADDRESS �` ► �-�i' i��l�d'� IW APN PARCEL SIZE: �� z � } CITYIZIP S f UCC )i/! C�/aT' BUILDING PERMIT# OWNER NAME (4 ILI ADDRESS Se - � CITYIZIP. PHONE NUMBER rt 3.1 01, 3. CONTRACTOR �MLL�I r'-�G� r ,///� y D ADDRESS l CITYIZIP CA-t-.e&-4= �� ,�� PHONE NUMBER ,aL'Jr2--7 ZZl GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ �, � 3 ❑ NEW INSTALLATION Q'RESIDENCE NUMBER OF BEDROOMS: IJ--REPAIPJADDITION - ❑ COMMERCIAL ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: 1 ❑ ENGINEERED/ALTERNATIVE F t CHARACTER OF SOIL TO DEPTH OF 3% [�I1�G� PITISUMP SOIL CHARACTER: c�. WATER TABLE DEPTH: i ❑ PERCTEST(S) HOW MANY APPLICATION# Ur SEPTIC TANK -'TYPE/MFG N-L ,, CAPACITY #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS ❑ PKCTX PLANT DISTANCE TO NEAREST: WELLai FOUNDATION .�, PROPERTY LINE-_W_ _ ❑ LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) Y�!EACH LINE #OF LINES: 3 LENGTH OF LINES: � j DISTANCE TO NEAREST: WELL� I r FOUNDATION r�_ PROPERTY LINE_ INFLITRATOR CHAMBERS: ❑ TILTERBED WIDTH - LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION - PROPERTYLINE © MOUNDED WIDTH _ LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE - ❑ SUMPS WIDTH - - LENGTH� DEPTH DI.STANCETONEARESP: WELL FOUNDATION PROPERTY LINE ZSEEPAGE POSAL PONDS WIDTH LENGTH- DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE '1 7 PITS # DIAMETER �i DEPTH 1S nISTANCETONEARIcr: WELL or}- FOUNDATION [ PROPERTY LINE 10 I HEREBY CERTIFY THAT 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. MINIMUI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL i(209).468-3423 '1 SIGNF : L TITLE: '*nr,,kCe�fv� DATE: o L D _.._._..._.. _..... .-_. _..__..._. .._.._._-_.___._.._.__.._ _-._. _.__._.._._.._,.................... ......- -f-.- i-.-_ -. � ... _ 4 ... � _ �__ _— _.L___..1_.__.__�_.__._i I E ! I I E 3�- �.__. .a � � 1�,,..4•t �r_-_I ------ . I I , ---- i I -- I I _ ............ {I I -_ _ f , I { I 3 , I C. , I� I _ I I I _.I f _----------- _ _ _ ._._._._ _ E 3 I I s F ' 1 } , f � ___. _..._... 1_._._. !. I .................. 'aI : I I I .....� --� , I � Ct f I .._.. _- + - f - . J _ G �.__. __...._ ! _._._._._I_ I I i.._ 4 ..._ _. ... _. ....._._. --------._—..............-.-. I - 1_.,__ I._... : ..._ ._..i--! ' -- - - ..... - -- I E I I I I 1 I DEPARTMENT U.JE O ' .Y APPLICATION ACCEPTED BY: r r lY �� DATE: 7AREA�EMPLOYEE ID# q(STRICT LOCATIO �� 9/ —sl INSPECTED BY: DATE: PERMIT FINAL YES bA7E:-' 2 1PEC '�-•` + COMMENTS: - P PE CODE SC INFO AMOUNT CHEC ICASH RECEIVED DATE PERMITIS£RVICE REOUESTN INVOICEN SEPTIC IDN REMITTED BY q2-lo ��' �� baa -C.t7Z� REVISED R-15-01 1