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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PLIALIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 G.WEBER AVE 3"FLOOR,STOCKTON,CA 9520212(19)4644-3420 <br /> 11:'N.711110ABLE PERMIT EXPIRES 1 YEAR FROM DATE <br /> /ISSUED <br /> APN D'✓•1 1�/L,~IZ PARCEL SIZE:�_�S <br /> CITY/ZIP .-zL 1�/n���`•I`t [,.y✓ ` 81:11.DINC PERMIT M__ <br /> OWNER NAME_ /I._GI(/ �C/�t�Q/. _.f ADDRESS /��77V- ��C•C - <br /> CITY/ZIP PHONE NLMBER-7U5 _7 6 --S ? <br /> CONTRAC`T'OR --. -_ ADDRESS _ <br /> CITY/71P ._ PHONE NLMBF.R <br /> GEOGRAPHICAL INFORMATION: COORDINAMS:X Y. TOWNSHIP_ _ RANGE_ SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBEROF LIVING UNITS: <br /> ❑ NEW INSTALLATION O RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIWADDITION O COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> 4'G DESTRUCTION13OTHER <br /> ❑ ENGINEERED'ALTFRNATIVF. <br /> CHARACTER OF SOIL TO DEPTH OF 3':_ PIT/SUMP SOIL.CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY APPLICATION N <br /> ❑ SF.PTICTANK TYPE%MFG CAPACITY Y.OF COMPARTMENTS <br /> ❑ GREASE"TRAP TYPFJMFG _ CAPAC.ITY N OF COMPARTMENTS l` n <br /> ❑ PKGT'X PLANT DISTANCE TO NEARE.S'1': WELL FOUNDATION PROPERTY LINE--_ <br /> ❑ LIFT STATION SIZE TYPF.OFPUMP SAND OIL SEPAKATOR(ENCLOSED SYSTEM) ((� <br /> ❑ LEACH LINE N OF LINES: LENGTH OF LINE'S: DMANCETONEAREST: WVI.t FOUNDATION PROPERTY LINE L' <br /> INFLITRATOR CHAMBERIS: ,fL1• <br /> ❑ FILTERBED WIDTH LENGTH DEPTH__ DLCTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE l <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_— DLSTANCETONEAACST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH__ IFNGTM DEPTH DWIANCETU NEAw ! WELL FOUNDATION PROPERTY LINE A <br /> ❑ DISPOSAL PONDS WIDTH LENOTII DEPTH DiSTANCETON-IM: WELL FOUNDATION PROPERTY LINE , <br /> ❑ SEEPAGE PITS N DIAMETER DEPTH DE-rAncE TO rvF..RECF: WELL FOUNDATION PROPERTY LINE_ <br /> 1 HEREBY CERTIFY'THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BC DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)464-3423 <br /> SIGNED;-_ �t. �j1...�tl�mti� _TITLE• DATE: <br /> 1 <br /> I <br /> - 1 ' <br /> -- <br /> 1 <br /> . <br /> , <br /> / <br /> , <br /> . _ <br /> I <br /> 1 . <br /> „ <br /> - - <br /> 1 , <br /> ,_......�__...�...... T . . _ _.__._...... <br /> 1 <br /> t t ! 9E. IVE-0 <br /> tw <br /> - - <br /> 9i : <br /> j i MT B �� ! <br /> DEPARTMENT YSEOy-.yY J(�y <br /> APPLICATION ACCEP ED HY DATE:�. b " -AREA PLOYEE IDN cot <br /> V DLSTRI _ ___ ATION <br /> gNY•o2 I/ 4¢yoL <br /> INSPECTED BY: y_ OAIh: PERMIT FINAL IB YES DATE: INSPECTOR. <br /> COMMENTS - IiC l!/L/J/ L//LL//d� <br /> PE CJUE SC NFO AMO NT CIIECKE. $N RECEIVED DATf. PERMR—RVKE REQUEST,I INVUICE� SEPTIC IOY <br /> REMI'ITLU RY <br /> 7`� <br />