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LIQUID WASTE PER%stf <br /> ` SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3`'FLOOR,STOCKTON.CA 95202(209)4611-7620 C <br /> //� `�►^ NO - ,NND,A�B�LEE PERM <br /> E�R11_EXPIRES 1 YEAR FROM DATE ISSUED \\\\r <br /> ` JOB ADDRESS / / ? A/ '^^ APN `�15O PARCEL SIZE: <br /> CITY/ZIP BUILDING PERMIT# <br /> ` OWNERNAME f�}� OBJ �j/ ADDRESS <br /> CIl'YIZIP PHONE NUMBER <br /> CONTRACTOR <br /> /- nl� �dj-� ��'� ADDRESS <br /> r <br /> C1T1'/ZIP PHONE NUMBER 9w <br /> r <br /> GEOGRAPHICAL INFORMATION: COORDINATES: % Y TOWNSHIP RANGE SECTION <br /> � <br /> TVPEOF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> r JIa-NEW/ INSTALLATION i&.RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIRIADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> Cl ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': �249j& PITISUMP SOIL CHARACTER: WATER TABLE DEPTH:_-JOd <br /> r �❑,/ PERC TEST(S) HOW MANY ��J`��APPLICATTIIOON# IfXV <br /> n <br /> ty SEPTIC TANK TYPE/MFG -fl/�L+#"-/�Tp CAPACITY �^ J V MOF COMPARTMENTS OC <br /> ✓❑_ GREASE TRAP TYPE/MFG CAPACITY MOFCOMPARTMENTS <br /> ` ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Cl LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ` LEACH LINE #OF LINES: LENGTH OF LINES: 1D ..i"CETONEARVW: WELL/ FOUNDATION/2� PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DISTANCETOFEARLNF: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH I DEPTH_ DEBANCETONEARLW: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DRTANCETONEARESF: WELL FOUNDATION PROPERTY LINE <br /> r ❑ DISPOSAL PONDS WIDTH LENGTH Q/, DEPTH_ UIWANCETONEARBW: WELL_ FOUNDATION PROPERTY LINE r <br /> SEEPAGE PITS M_�_ OIAMETEP�,�!-y DEPT17�/ mcTANCETONEAR"T: WELD" FOUNDATION/ PROPERTY LINE Ol/ J <br /> I 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 /> IMUM24 OUR ADVAN NOTICE REQUIRED FOR INSPECTIONS-PL ASE CALL(209)469-3423 <br /> r LT�#✓`�_ DATE: <br /> SIGNED: TITI. > �z' <br /> L 1 I - _. -- <br /> E t — <br /> 1 <br /> � 9r1S�f <br /> T <br /> f <br /> f -._I I C <br /> r7-.__I <br /> I <br /> DEPAR ENTUSEONLY C C <br /> r APPLICATION ACCEPTED B _ E: AREAEFIPLOYEE I I[ _ -DISIIUCT LOCATION <br /> .17 <br /> PER FINAL DATE: '✓ "� NSPECT R' <br /> INSPECIEDRY: AT <br /> 1 <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT CNECKNICASH RECEIVED DATE ------SERVICE REQUESTx INVOICE# SEPTIC IDN <br /> r ITTED BY <br /> r - <br />