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LIQUID WASTE PERMW <br /> 1 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(20914AN-1420 J/ <br /> �J E.FUNDABLF.PN:1JL/A1 ITJ`:XPIRES I Y'F.AR FROM DATE ISSUED 7 <br /> JOB ADDRESS / 2 / ! r / 7NOy-R r h'f \ APN 0 0 ?2 S'0— 46 Z, PARCELSIZE:./0 44,1 <br /> CITY/ZIP `11�`"�1yI•L 1 CA,I "1�/ � BUILDING PERMIT'q <br /> OWNER NAME lfY C'• •QrC� /" IC�^ ADDRESS <br /> CITV/ZIP /(� PHONE NUMBER <br /> � <br /> CONTRACTOR rvl«� ` ! �1 ADDRESS 2 ` lo' 04Lk <br /> CITY/ZIP �� �� � PHONE NUMBER ?31— /3745 <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 /> ❑ REPAIR/ADDHFION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> LIDGSTRUCTION L3 OTHER <br /> ❑ ENGINFERHD/ALTERNATIVE <br /> n <br /> CHARACTER OF SOIL TO DEPTH OF J': ^ PITlSUMPSOIL CHARACTER: WATER TABLE DEPTH:xFERC TEST ISI HOW MANY L O APPLICATION# I' T- 7-0 C) <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY �a OF COMPARTMENTS ` \ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY NOFCOMPARTMENTS 7S <br /> C1 <br /> ElPKCTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE (� <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE N OF LINES: LENGTH OF LINES: DMTANCETONEARvw: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DMANCETONEARM: WELL FOUNDATION PROPERTY LINE_ <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEARENT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH UENGTH DEPTH_ DISTANCETONEARESE: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH_ DISTANCETONEARESF: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS N DIAMETER DEPTH DISTANCE TO NFARF.W: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI�MUpI�1]y1��()UR ADV C 'NOTICE REQUIRED • ECTIONS-PLEASE CALL(209)468--33423 2) <br /> SIGNED: •r^"` TITLE: Cly<L ged/6 `DATE: / ' L/ <br /> ..... 1A- i 2�p <br /> _ <br /> ivy <br /> q .. r_ y .a,. is v <br /> t r <br /> I <br /> rL ,GG- <br /> .. . .....-..... I- t-._ {.. .. . <br /> L I 6'`d IL <br /> v <br /> M4 eco Nlacl �, A� 9 2303 <br /> f. <br /> t 1 �prl opQ SEfN� r <br /> I <br /> 1 <br /> �4 ; <br /> DEPARTMEN7 USEFONLV �'1 (/(/// JJ ' <br /> APPLICATION ACCEPTED BY DAT@C AREA !/ EMP'LLOYEE IDN DISTRICT ) LOCATION1 <br /> i INSPECTEDBY: I DATE//�, PERMIT FINAL�ATEf"7� INSPECT - -7- <br /> 717 <br /> COMMF,NTS:� /I{�� (t' 7' 0t _ I t'/'C� V•C (/ /U[ <br /> r <br /> PE CODEWINFO AMOUNT f ECK!C H RECEIVED DATE PERMITSERVICE REQUEST# INVOICE# NEPTK RM <br /> �J REMITTED I �J�BV V <br /> REVISF,D#-ISNI <br />