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LIQUID WASTE PFnz TTT ;x�OAQUIN COUNTY PU)3LIC HEALTH SERVICES ENVII ,'HEALTH DIVISION 304 E.WEBER AVE 3"0 FLOOR,STOCKTON,CA"M02(20T)468-3420 NON-REFUN ABLE PERMIT EXPIRES I YEAR FROM TE ISSUED JOB ADDRESSC�� APN V {'� 1�� O PARCEL SIZE:"T' c S -L 020 166 3 CITY/ZIP , 1 ` 1 �J � L1 BUILDING PERMIT 11 OWNER NAME J 0.w (� 1 ►i 1` J 1`-- ADDRESS CITY/ZIP -Tr /1'� \ .p v T b PHONE NUMBER 0 CONTRACTOR ADDRESS E Uri CITY/ZIP PHONE NUMBER GEOGRAPHICAL INFORMATION: COORDINATES: X Y_ TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: JJ NEW INSTALLATION )4 RESIDENCE NUMBER OF BEDROOMS: _ ❑ REPAIR/ADDITION ❑ COMMERCIAL ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: ❑ PERC TEST(S) HOW MANY APPLICATION# % SEPTIC TANK TYPE/MFGn— r a�V de, CAPACITY rZA00 ')Q4 , #OF COMPARTMENTS Z ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS ❑ PKGTX PLANT DISTANCE TO NEARE9T: WELL FOUNDATION PROPERTY LINE �. ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) C LEACH LINE #OF LINES: �V LENGTH OF LINES: /Loo DISTANCETONEAREST: WELL/CV FOUNDATION 3LO I PROPERTY LINE INFLITRATOR CHAMBERS: ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DI.STANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH DICTANCETONEAREST: 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 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 SIGNED.-c=�- TITLE: DATE: - -k- _ r I y'' IOC _-...f ..---. -- - .... _. - .._........- -._.... _ _ ._:......... ... _... .......... —......... - - -- - -.._. ..._._.._.........._......d.I........................_.._...._....._ - - --- - -\ : E '_ � -- _ __ ._-_ __ >___ .._....._ -_ _..- __ __-.._ .. _.. - _ __ __ __ __ _ _�_. -'� _ _ I U Ty ...._.__._..........__.._......................_._. .......-�-_ - --- J AU N �._.._..... .. A U ;._._.._. _.. --....�...... -.....-� .... ......__ .............................. f_...H_............... .... _.._..! i......._ ........ I......... ... _.......a............i_........................}..... .. ......_i -_._. �..... �... .. - - __ - -- - -- -- _ DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. (V..MM1M V 5 0/tJ DATE: L� y AREA EMPLOYEE ID# v DISTRICT'-�LOCATION_n r INSPECTED BY:�L �Y//V��DATE:l DPERMIT FINAL�ES DATE: D�fNSPC•CTOR:��e��r"'v ' COMMENTS: PE CODE SC INFO AMOUNT NCHECK ASH RECEIVED DATE PERMITISERVICE REQUEST# INVOICE# SEPTIC ID# REMITTED BY' REVISED S-15.01