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"� LIQUID WASTE PERMIT <br /> SAN' R UIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTA 6TH DIVISION <br /> 301E.WEDER AVE 3M"FLOOR,STOCKTON,CA 95202(209)47,4 20 <br /> 1 (/�,.. L NON-REFUNDABLE PERMIT EXPIRES I YEAR FRO 1 DATE I.tiSUED <br /> JOB ADDRESS � µ- VCG 1Z 'D` APN �S� PARCEL SIZE: �I� <br /> CITY/ZIP -+ BUILDING PERMIT Al- <br /> OWNER NAME LT[�j _ �L-IA"^� F>�_ ADDRESS •i1-cx- <br /> u <br /> CITY/ZIP PHONE NUMBER <br /> CONTRACTOR ~ �� �• ADDRESS "2"LRM' L.o rY.y <br /> CITV/ZIP AQb PHONE NUMBER �b6 <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: <br /> ❑ DESTRUCTION ❑ OTHER EPAIR/ADDITION L3 COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY <br /> /APPLICATION# <br /> xxSEPTIC TANK TYPE/MFG— Ilt CAPACITY #OFCOMPARTMENTS <br /> GREASETRAP TYPEIMFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST:- WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES:_ DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> V <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ DLCTANCETON"RLW: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DLWANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE <br /> ❑A' DISPOSAL PONDS WIDTH LENGTH DEPTH_ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> yy SEEPAGE PITS # DIAMETER_ DEPTH DISTANCETONEARECT: WELL FOUNDATION PROPERTY LINE <br /> //I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS n <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. lel`•" <br /> MINIMUM}21 HOjUR DVANCE NOTICE Rj;QUIRED FOR INSPECTIONS- LEASE ALL(209)dbR-342J 1 <br /> SIGNED: <br /> T- /JL TITL DAT �I ' <br /> i <br /> I <br /> i TT <br /> -#................ <br /> 1 <br /> . ... 1i i......- ' I _ <br /> -_ �._. _ ....E�7i- �...... - t �-- ---.� i <br /> _ -01 <br /> _ <br /> I � I <br /> L-4-- <br /> �4 <br /> -- 1 <br /> r zmz <br /> —� <br /> — — — — —+— — <br /> i t <br /> _ 1 <br /> UA Iu7t <br /> DE <br /> PARTMENT SE NLV <br /> APPLICATION ACCEPTED BY: D�Ay)T�E✓1^ AREA Z EMPLOYEE IDM 149-)f DISTRICT LOCATION <br /> INSPECTED BY: DATE:_ I�V L~/PERMIT FINAL DATE: INSPECTOR: <br /> Ll- <br /> COMME TS: •I 1['N1D SPLHC lar T/rL / \ 'l/ <br /> F� 1s w4c/ C Jci�CJuaFSJ� �AsY� R1 !> /iY� �*91 <br /> PE CODE SC INFO AMOUNT ❑IECKN H RECEIVED DATE PERMITSERVICE REQUESTM INVOICE. SEPTIC IDM <br /> REMITTED BY <br /> L4- f pyo �� <br /> G /02-1 <br /> RETRIED-1."t <br />