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LIQUID WASTE PERM <br /> SAN 30AQU[N COUNTY PUBLIC HEALTH SERVICES ENVIRONMENT, 1EALTH DIVISION <br /> 304 E.WEBER.AVE 3"'FLOOR,STOCKTON,CA 95202(209)468-3420 <br /> hh A ) NON-R FUNDABLF,PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> .IOBADDRF:SS _Li�l (;� /N/ �' ,`-� AP N a 7 (J PARCELSiZE:/ <br /> CITYJZIP '�-.1�^-" BUILDING PERMIT 4 <br /> OWNERNAAIE / - � � C:.f. -- - <br /> .//� _ ADDRESS_.__.O `(pq_ � .? � <br /> CITY/ZIP 5A-6111 - ��� „- r �'. _ PHONE NUMBER - <br /> CONTRACTOR__LL-.-'/�L-! J� -�'�� ADDRESS_ <br /> aTYrrlr -/� �t Z-E'l <br /> PHONE NUMBER <br /> - GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TVPF;OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:- <br /> Ll NEW INSTALLATION LJ RESIDENCE �^ <br /> NUMBER OF BEDROOMS: --4❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE - <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: _ WATER TABLE DEPTH: <br /> PERCTEST(S) HOW MANY APPLICATION# of 00 r VOQ <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OFCOMPARTMENTS �.- <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY #OF COMPARTMENTS � <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE _ <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES' LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL 'FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEARFCT: WELL FOUNDATION PROPERTY LINE T1 <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE C <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO 1 <br /> O,NEAREST: WELL FOUNDATION PROPERTY LINE � <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> - <br /> t HEREBY CERTIFYTHAT I HAVE PREPAREDT S 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 />` r /#IOU DV`NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(249)468-3423 <br /> SIGNED. f TITLE: ( 1/V it& DATE: �-- <br /> �f <br /> 4 <br /> a..,.. <br /> : <br /> C : I <br /> ti .. <br /> rzzr <br /> ' <br /> mow.. <br /> .. ._ . ., _ <br /> . <br /> , I <br /> DF,PARTMEI T USE O{N�LY <br /> APPLICATION ACCF,� Y:��I.MJ( �pATE� 1" V AREA,,z.rj.,-EMPLOYEE IDN q/ DISTRICT+'' 'LOCATI OIV <br /> I INSPECTED R _DATE'_`�/�/ULA PERMIT FINAL dY YES DATE:./// OZ 1NSPECTO ' <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT CHEL'Kgr,ASH RECEIVED DATE PERMIT/SERVICE REQUES74 INVOICE+ SEPIIC IDN i <br /> REMITTED py <br /> I <br /> REVISED 8-1s-ol <br />