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LIQUID WASTE PER1"`TT 7� �,tN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRON L HEALTH DIVISION GEr/(v". 6;D' 304 E.WEBER AVE 31P FLOOR,STOCKTON,CA 95202 09)468-7420 ^� ( r E• '^F'Y JOB ADDRESS NON• EFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED J r' L�•,�.,b�J�J 11 'af'� '(�(� R(� APN l i I 'rL110 - -7-1/ PARCEL SIZES CITY/ZIP_ J�'NII�-'/ R'fW/� yy,, •�F� Q � ry// �,1�- BUILDING PERMIT k OWNERNAME �--�-V Iy'IV Y O IY 1 AI opTJDS J`�DDNE$S CRY/ZIP �J PHONE NUMBER CONTRACTOR f^=oZ�� (j_/1A — jz .�, L(// v ADDRESS S� YjL--Y"7 CITY/ZIP PHONE NUMBER e7'41 T/ - I 3�4.5 GEOGRAPHICAL INFORMATION: COORDINATES: X V TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: X ❑ REPAIR/ADDITION ❑ COMMERCIAL L ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: _ X ❑ ENGINEERED/ALTERNATIVE T CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: FERC TEST(S) HOW MANY 1 APPLICATION# �- ❑ SEPTIC TANK TYPF(MFG CAPACITY #OFCOMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS [ ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE _ ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) #OF LINES: LENGTH OF LINES: C L3 LEACH LINE DISTMCKTONIDREST: WELL FOUNDATION PROPERTY LINE 1 INFLITRATOR CHAMBERS: ❑ FILTER BED WIDTH LENGTH DEPTH_ DICTANCETONEAREST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREVT: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH_ DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH .DEPTH DISTANCETONEAREm WELL FOUNDATION PROPERTY LINE ❑ SEEPAGE PITS IF DIAMETER_ DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY UNE I HEREBY CERTIFY THAT I HAVE PREPARED T14 APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS ND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. A,NCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)466-3423 T�Nf4//c1Fs�D zfi oZ SIGNED: TITLE: ATE: l I - �.. • •• - - MANILR BRIGGS RR0 COEL I-- I_ ------ TREWERT RB. Kul eUS T -.- RERN RD.�...... M _ Q •• DE LIMA RR. 3.3 r L___ O J r I I OOS REIS R0. B HiY J3 La�h(OD uTH r —�— T\+ I o I ® T IS. LOU 9E 7 EL.'22AV ¢ I r_ y... SITE PLAN i'.�" r—� r -"-. ' I 1 L... a .......F 4 -- �� I �__ �_ I I UG�2 7 �OQ2 1- - M DEPARTMENT US^E�ONLY I /y EINRONMENNT H,EALTH DMI N APPLICATION ACCEPTED BY: U GSM 5T v DATE: � L•�' XREA l�/� EMPLOYEE IN V 3^6 DISTRICT 3 LOCATION INSPECTED BY: OATE�PERMIT FINALJY YES DATE: INSPECTOR: COMMENTS: •ls P �• 7 '// - PE CODE EC INFO AMOUNT .NEC .ASH RECEIVED DATE .PERMIT/SERVICE REQUEST# INVOICE# SEPTIC IN REMITTED BY qz� Z 5z1 89 1 SRw7og9R REVISED R.I"I