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LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PU)3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION C(O'o 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(209)468-3420 i'� �P- JOB ADDRESSI SD _ EFU-&PERMIT EXPIRES 1 YEAR FROOM QATE=SSOUED PARCEI.SIZE:[ - s CITY/ZIP�,A�� •E� 10" BUILDING PERMIT k f3 P -0032-0�J OWNER NAMEC3 IN(TH p6LDII t' &Am� K ADDRESS27.32 �'rTw�flFy /� CITY/ZIP. /+ ►� �0s�__ �� I��f� PHONE NUMBER 6gr - + `�� CONTRACTOR�•�' � � ✓� �✓ ADDRESS ` k) - Nd'%W WAW CITY/ZIPv ,�1 5 PHONE NUMBER! Q � ,/�+�i GEOGRAPHICAL INFORMATION: COORDINATES: X_ Y-- TOWNSHIP RANGESECTION TYPES OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: ❑ REPAIR/ADDITION J'( COMMERCIAL 2 NUMBER OF EMPLOYEES: ❑ DESTRUCTION ❑ OTHER ❑ ENGINEERED/ALTERNATIVE C /� CHARACTER OF SOIL TO DEPTH OF 31: ✓ PIT/SUMP SOIL CHARACTER: D WATER TABLE DEPTH: 20 ❑ PERC TEST(s) HOW MANY APPLICATION# x SEPTIC TANK TYPE/MFG_ CAPACITY 1 60 / #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG y/�/ CAPACITY #OF COMPARTMENTS LlPKGTX PLANT DISTANCE TO NEAREST: WELL1E�� FOUNDATION �+ PROPERTY LINE 7 ❑ LIFT STATION SIZE TYPE OF PUMP d SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINE #OF LINES: LENGTH OF LINES:-1 O DISTANCE TO NEAREST: WELLM6 FOUNDATION 40 PROPERTY LINE 15 INFLITRATOR CHAMBERS: �S QED LINE ❑ FILTER BED WIDTH _ LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE SUMPS WIDTH LENGTH1Q_ DEPTH DISTANCE TO NEAREST: WELL= FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑' SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. M IMU 4 OUR V NCE NOTIC�REQU�IRED OR INSPEC_TIONS � SECAL (2 9)468-3423 SIGNED: 21 0� �nQ J TITLE DATE: _.. ..............__-._...._......................_.... - - - -- - - - - --- _... : ..................................... ..... i .......... , ............. ;_..:i. ..._.. -._....._........_ ....... _ --.....__. -- �l _ ..... . ......_ ................... - f_._ .... .__ .............. _ _ I D ..._._....... .............. �._.. ........ F•._....._. ............ �.._........................_... _ _. _ _.i.. >'...h.. _ �...._......t.. j ENI l. ............... _..... _ __ ... .. ys i _ ......... .............................. .........._............................._... ._. . __...._ 1 � t I i : I�........ . ... . . . _. .. .. ..................... .... -- : _.... r . ........... ........................................_..............................._._..... ..... _......................................._............................................................._......__..................._._.................._.................._......._... -.._................................_.._..............._............._.......... _..... ................ __............ .......... . _....... I : DEPARTMENT USE ONLY qq DATE:97r 13.. ` AREAEMPLOYEE IDM 131 DISTRICT__+LOCATION , APPLICATION ACCEPTED -- DAl I' /� rya/ C/ PERMIT FINALES DATE:__]NSPECTOR: 77 INSPECTED BY: - COMMENTS: PE CODE SC INFO RTM-OUNT/T EMITTE (�HLCKM/ ASH RECEIVED PERMIT/SERVICE REQUESTN INVOICEM SEPTIC IDM DATE