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IQU I)WASTE PERMIT <br /> SAN JOAQ JRYPUMLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISIDN <br /> �Afr/EBER AVE)"'FLOOR,STOCRTON,CA 9530300914M-3420 11. / O / // <br /> JOBADDRE55 / / /^/[ NO�NN�UND P9:01gF.RMIT F,%^ f:S)F.AR PRO'AO�SSO9 PARCELSIEUEJ-23v[& <br /> CITIZU, S-ro�L!✓/�JX� �OO- BUILDINGPERMIT,Yx9-3! < r <br /> OWNIHlAME ADDR <br /> /1lEBS ��T,•W'� <br /> CDlml, E/n", <br /> n Lam' PHONE NUMBER <br /> CONTRACTOR V-j-�/pL=�x z-,Ja,12- ADDRESS y -� <br /> ` <br /> I'ITYOP 548mC &,j 7 <br /> <+�J PHONE NUMREP 9YsC—l;�/S� + <br /> GEOGMPHICALINFORMATION:COORDINATES:% _ Y- TOWNSHIP RANGE SECTKlN— <br /> TYPEOP SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OP LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIWADDITION ❑ COMMERCIAL <br /> Ll O OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEEREWALTERNATIVE <br /> CHARACTEROFSOILTODEPTHOPI': PITISUMPSOILCHARACTER: WATER TABLE DF.PT'I1: <br /> PERC TEST ISI HOW MANY If APPLICATION <br /> ❑ SEPI'DI TANK TYPVMFG CAPACITY ROFCOMPARTMENTS <br /> ❑ GREASETRAP MEMFG CAPACITY NOFCOMPARTMENTS <br /> ❑ PKGT%PLANT DISTANCETONEAREHT: wELL FOUNOATNNJ PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE NOF LINES: LENGTHOFLINFS: orerMcvonuNai: WELL FOUNDATION NRDPERTY UNE <br /> INFLITRATOR CHANHIMS: <br /> ❑ FILTER NEB WIOTN LE. DEPDI N.WX TONiw.: WELL FLIVNDATION PROPERTY LINE <br /> ❑ MDUNDED WIDTH LENGTH DERV_ NRTMC6ttIX6AP4T: WELL RAINDATIM PROPERTY LINE <br /> ❑ BUMPB WIDTH LENGTH DEDTH NEaTMCa TON[MCaT: WELL FODNDATON PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH_ NMTMCaioxcucaT: WELL FOONOATION PROPERTYLINE <br /> ❑ SEEPAGEPITS M DIAMETER_ DEM- NIFTMCi TON6MVT; WELL FOONDATKKI MIOPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIFIOPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SANJOAQUIN COUNTY ORDINANCES.STATE LAWS <br /> RL.AND REGULATIONS OF BAN JOAQUIN COUNTY. <br /> 1 U RA V CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)NNR-34B '� <br /> O <br /> SIGNED: TITLE: Ti+tGT,VisaiRt_ DATE: <br /> I I I I I <br /> L*a �o _ = I RECEIVEC <br /> = ``j 7M1 JCA <br /> FUOLIONPN TY <br /> 1'NIR(WMK(YAU. F <br /> PRELIMINA-KY SITE PLAN —.I. <br /> -. N MN9'MNp <br /> .. <br /> Q -- DE MENTUSEONLY �JIo I J,JRX <br /> AALWAU.N VATE: /^��^ AREA / .E�M/PLOYEE ID tl T LOTATIOM^' <br /> INSPE(TF.UB DATE '/`PIT FINAL AYES IIAT[:% E <br /> !YA <br /> S. <br /> R<pDE 9f O AMOIMi CN RFl41VE0 PERMDISERYKE REQVFSM1 IXWRE. SEPTICIp <br /> RFMRTEO BY <br /> a 3 7 , <br />