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LIQUID WASTE PERMIT <br /> SAN]0- .N COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL H, _­HDIVISION <br /> 304 E.WEBER AVE 3ND FLOOR,STOCKTON,CA 95202(209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> - <br /> JAPN PARCEL SIZE: <br /> (]8 ADDRESS Ll 1+,/ 1 `� G'"S-�` �D�^1- [r _ R(J <br /> I C1TYlZlP � '// ! BUILDING PERMIT# <br /> OWNERNAME 6L- - t%u II f` o T. ADDRESS­ssajo-- <br /> CITY/ZIP - PHONE NUMBER <br /> CONTRACTOR --f" ADDRESS W SO <br /> CiTYlZIP PHONE NUMBER <br /> k <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_. <br /> ❑�NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: Z <br /> fid' REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3% PITISUMP SOIL CHARACTER: WATER TABLE DEPTH:' <br /> f ❑ PERCTEST(S) HOW MANY APPLICATION# <br /> + ❑ 'SEPTICTANK TYPE/MFG_ CAPACITY 4O COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY 4 OF COM PARTM ENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST:'WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSEDSYSTEM) <br /> f , <br /> P- LEACH LINE # LINES: LENGTH OF LINES: p15TA¢CETONEARES7: WELL-.__ FOUNDATION_LC� _ PROPERTY LINE_6 , <br /> I ]NFLFLITRATOR CHAMBERS: " <br /> I <br /> ❑ FILTER BED WIDTH LENGTH - DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> kI ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> I ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LME <br /> I r` t . <br /> I IEPACEPITS #._- DIAME7ER.3G DEPTH DIRFANCETONEARKST: WELJ r y7� FOUNDATIONS PROPERTY LINE <br /> I HEREBY CERTIFYTHAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL 13E DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS 1� <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> !HINT UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-33423 J <br /> SIGNED: TITLE: 4:�-C-sYl j{y C�n l DATE: <br /> , , <br /> ' <br /> , <br /> I - 4= ; {... <br /> �.--_ ......... ....... ..,._._, - <br /> I ' I t <br /> { f. <br /> ..__...____ -.... ..._...�. I I _ <br /> I <br /> I I E I <br /> - <br /> . <br /> ( <br /> ..,..._.._ J i <br /> rCl <br /> C <br /> T1IrteRION .._ <br /> .__ <br /> ,I <br /> Il <br /> - <br /> . -l . .................s <br /> .._............. ............. ..................... _._.... .. .. <br /> .-. <br /> } , <br /> L I <br /> ' } 5E <br /> -'- --'i_.-. � <br /> _ ,y <br /> , I . /If1 <br /> f' <br /> Ij <br /> ....._. ._._._.._ 3 , �I <br /> ,)ti <br /> tr.'. <br /> ._... <br /> DEPARTMENT S <br /> APPLICATION ACCEPTED BY: DATE: EMPLOYEE IDM DSTRICLOCATION <br /> N <br /> INSPLE:T0INSI%CTFD Y: DAFINi YES.DAT <br /> COMMENTS: mg-- <br /> PECODE SC INFO AMOUNT CHECK CASH RECEIVED DATE PERMITISERVICE REQUEST10 INVOCSEPTIC IDO <br /> REMITTED 13Y " <br /> ... <br /> VISE D N•I S_01 <br /> i <br /> , <br />