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LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION '.- • 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(209)468-3420 A 1 NON-R' BLE PERMIT EXPIRES 1 YEAR FROM ANTE 1,S'S�UED)� �C JOB ADDRESS 7&Ir —✓ �'I AP N CJ I UUU PARCEL SIZE:_ CITY/ZIP BUILDING PERMIT M OWNER NAME` F—il,e.r� t.c,�... ADDRESS—�A'W� i CITV/'ZIP PHONE NUMBER ��,-, C,� _ CONTRACTOR �/ ��G "' \ ADDRESS ! I ��-� -�'� `�A'(29 CITY/ZIP PHONE NUMBER �+ L(_ V GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: L ❑ NEW INSTALLATION ��uco IDENCE NUMBER OF BEDROOMS: — jkEPA1R/ADDITION MMERCIAL ((�—❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: ❑ ENGINEERED/ALTERNATIVE _/ i CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER:��*lr? WATER TABLE DEPTH: ❑ PERC TEST(S) HOW MANY APPLICATION# ❑ SEPTIC TANK TYPE./MFG CAPACITY #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE al. ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) Y EACH LINE #OF LINES: LENGTH OF LINES: I-to DISTANCE TO NEAREST: WELL�� 04-FOUNDATION V PROPERTY LINE C) IX- TRA' R CHAMBER ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEARV.T: WELL FOUNDATION PROPERTY LINE LJ MOUNDED'!' '� WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ,M:*, ' ❑ SUMPS WIDTH- i'H DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE r �2s DISPOSAL PONDS WIDTH LENGTH2/� DEPTH DISTANCE TO NEAREST: WELL /� eqFOUNDATION PROPERTY LINEtEPAGE PITS # I DIAMETER JI[/ DEPTH DISTANCETONEARE.ST: WELL/CO FOUNDATION PROPERTY LINE-I HEREBY CERTIFY THAT 1 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. « MI MU HO ADVANC TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 )-7 S ` SIGNED: TITLE: DATE:/ -13-0 ... 1 .............E........_..;..........._............. ----- —...�.. ..._._ I _ t t ...................... ; _j ____........ ..�.-----... ... a_ ....... ....._j -................... ............�........._ ... I — i i ! � E I I I i yr— _....i......__.,.--......�____�____....�.___+ _.._. . —4L _ _ — ______ ___ _ _ _. —__ __._____1.._.a..-..__ -.j_......i.......... .__y..._-__�--.-.i-- ' i- {f! 1, i�* : ;