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LIQUID WASTE PERM — <br /> /OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONME HEALTHDIVISION <br /> M0 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(�W-3420 <br /> JOB ADDRESS Ilo 7 `" N �.\A/y 99 t—REP <br /> BLE EXPIRESA59 FROM QDATESUED PARCELSIZE: (A <br /> CITY/ZIP Lo a) iC+ T(-,q„^�„'�B-UILDING PERMIT 0 11 6 /- <br /> OWNERNAME 1�4 XX,�,,QS �/QXI ch { e ((]]P-� ADDRESS (Y ` Ir,, <br /> Po O NyY 101 C l E ttnentS CA 95ZZ� PHONE NUMBER liy q/ 4--7 v q 4-0 o <br /> CITY/ZIP y� 11,, _ <br /> CONTRACTOR D. A.Q 1• �AYI �S 1 l ADDRESS <br /> CITY/ZIP PHONE NUMBER <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 /> Dl <br /> ❑ REPAIR/ADDITION COMMERCIAL Gl <br /> X DESTRUCTION /❑`OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE 6 <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SU MP SOI L CHARACTER: WATER TABLE DEPTH: <br /> G <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTIC TANK TYPE/MFG Concre+t CAPACITY 'LOOO #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) L( <br /> 13LEACH LINE #OF LINES: 3 LENGTH OF LINES:_ <br /> I,7 C DLttANCt TO Numw: WELL 17 7Q FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: - <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DISTANCETONBAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ DISTANCETONGREST: WELL FOUNDATION PROPERTY LINE C <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DISTANCETONEARM: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH p DEPTH DIRANCETONEAREAT: WELL {X.J� FOUNDATION PROPERTY LINE <br /> LIL{.O <br /> SEEPAGE PITS # 3 DIAMETER III DEPTH DISTANCETONEAREeT: WELL 71W1 FOUNDATION PROPERTY LINE 1 <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 /> 11 IM M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)/6&3/23 <br /> SIGNED: TITLE: DATE: <br /> 'ALL 21 LF <br /> I/2• WATER <br /> UN <br /> _ ROM _L <br /> msrxu xe• <br /> — / u <br /> �9> <br /> i <br /> i <br /> .I_ '{_ y _. _ l..- -.._-- j.._.__._ —_ -. . _ _ �i�a• o-Box h <br /> J. <br /> L. 4 2,� <br /> M <br /> _..... l .._ _ .. MwIw µ <br /> 20 a Q o <br /> . (J�l <br /> x <br /> 'MMRT.Y`TILLER CGrvxT <br /> 1 f <br /> APPLICATION ACCEPTED BY: DATE: ) y�� T/ZAREA EMPLOYEE IDX S�g44 ��IST��RICT�LOCATION <br /> INSPECTED BY:� J1 ) DATE: /C-3 PERMIT FINAL YES DATE:// //"-/ INSPECTORS <br /> COMMENTS: In ALA LVInwrtial Asigftrr, dejlrc4 'I•Ank - CY/, /�k.t �Gok� i..3L ?A13eZ.f4o'I+S'/.✓mac <br /> PE CODE SC INFO AMOUNT CHECKMVC SH RECEIVED DATE PERMDSERVICE REDUESTM INVOICEX SEPTIC IDX <br /> REMITTED BY <br /> 10 15S Sd0 /�/saz- S(�0031 X06 <br /> X4221 071T $9 Fogy <br /> REVISED 0-1--01 <br />