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LIQUID WASTE PERK JOAQUIN COUNTY PUaLIC HEALTH SERVICES ENVIRONMEI HEALTH DIVISION • - ✓ 364 E.WEBER AVE 3k"FLOOR,STOCKTON,CA 452021204)469-3420 NON-REFUNDABLE PERMIT EXPIRES I VEAR FROM DATE ISSU D JOB ADDRESS l APN I � �4� vA r PARCEL SIZE. a .S 7 A CITYIZIP Ghemfioa4U BUILDING PERMIT p OWNER NAME �L/C~�C.P ,. � J F� - ADDRESS CITY/ZIP 916-3 26 PHONE NUMBER CONTRACTOR ADDRESS CITYIZIP PHONE NUMBER ' 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 L3 DESTRUCTION Ll OTHER NUMBER OF EMPLOYEES: ❑ ENGINEEREDIALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: ❑ PERC TEST(S) HOW MANY APPLICATION# e-SEPTIC TANK TYPE/MFG CAPACITY t(ODC)aak #OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS r ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE �. ❑ LIFT STATION SIZE TYPE OF PUMP - SAND OIL SEPARATOR(ENCLOSED SYSTEM).- LEACH #OF-LINES: � LENGTH OF LINES: �msrente rOnBAR&ST: ��WEGL' �FOUNDATION 4O � PROPERTY LINE � ❑ LEACH LINE 6� C INFLITRATOR CHAMBERS: ❑ FILTER BED WIDTH LENGTH DEPTH . DLSTANCEYOnEARFfiT: WELL FOUNDATION PROPERTY LINE C ❑ .MOUNDED WIDTH LENGTH' 'DEPTH :DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE L ❑ SUMPS WIDTH .LENGTH DEPTH DISTANCETONEARE.IFI WELL FOUNDATION - PROPERTY LINE - ❑ DISPOSAL PONDS WIDTH LENGTH - DEPTH �1 DISTANCE TO NEAREST: WELL FOUNDATION 1 PROPERTY LINE r ❑ SEEPAGE PITS # _ DIAMETER `Zf DEPTH LS:' oISTArCBTOnEARE.ST: - WELL ,FOUNDATION t O PROPERTY LINE r F C 1 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 SANJOAQUIN COUNTY. f MINI UM 24,HOUR A ANCE NOTICE.REQUIRED FOR INSPECTIONS—PLWE.CALL(249)468;3423. SIGNED: TITLE: DATE: i .. ' i I --- - --- -- - -._._.--- -- - - -- , Q -- - --- -- d--KY- - - - - - -- -- _ - , I '-.----s_.__._3._._._:!........; i - ..............---_4...._._... _.._._..._._._._ �- - i ..».j-..,,... F _....I_..... ._ .._._.L_._ ._ � _._.._ .__.. - ._.__._. I t--1-1-11-11-1-1-1-1 _.__._.L.___.. .......... 1..._ l _i C--1- 1-- --- - i. i.. :_..._. --- - :. t .. - - -- .. .. _ .. .,... I t- r - 1 r I f � I I _.Y._ S 7t�f�fl'liV-�i7 t�tfi � _ _.._.... ---.._—_....:.........._.�_ 1 _...... ._. .,.._P UC1111HE K EP.IC _- -- _. -�= �F EfR DIVI.fUl a•ir ,wr ' . fl _ IRQNM N I I a _€ _ DEPARTMENTUSE ONLY - .APILI'CAT741N ACCEPTED HY: •V VI/VMJ «JUN�(..SJ'./ DATE 7 r AREA �`.. EMPLOYEE 1Dp �"� D TRIeT ',LOCATION z INSPECTED B - - DAYE'` — y[l PERMIT FIN�,YES DATE.�_IN COMMENTS: . E DE SCJNFO AMOUNT HEC #!CASH. RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# - SEPTIC IDN P CO REMITTED - - BY 4ZI� 111 31.0 . ioa 3 L41. . 7 $ oa .Sf�003040 S REVISE:n x Is of