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LIQUID WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 301 E.WEBER AVE 3q'FLOOR,STOCKTON.CA 91202(209)I6R-3420 <br /> ell-* <br /> BLE PERMIT EXPIRES 1 VEAR7FROMM DATE ISSUED <br /> /' A-C <br /> JOBADDRESS- .��'�f N*T APN SJ (/ /f/ J�(�g C, PARCEL <br /> PARCEL SIZE:_ <br /> y� BUILDING PERMITT&& ( I V / <br /> OWNER N'AME�I/1e&- �(.i/�" J ADDRESS <br /> CmrzJP PHONE NUMBER-- <br /> J <br /> op <br /> CONTRACTOR��/v�Y,�_ v_� ADDRESS 1n{ <br /> Cn-YTZIP PHONE NUMBER 7-Y7 7.2-7V- <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X V TOWNSHIP RANGE SECTION_^ <br /> Y. <br /> SEPTIC WORK: INSTALLATION WILT.SERVE: NUMBER OF LIVING UNITS: <br /> EW INSTALLATION O RESIDENCE. NUMBER OF BEDROOMS:, <br /> REPAIR/ADDITION ❑ COMMERCIAL - <br /> �L,-2 ✓, NUMBER OF EMPLOYEES: <br /> O DESTRUCTION -" OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': __ IT/SUMP SOIL CHARACTER: WATER TABLE DF.PTH:­ej�') t <br /> `❑ PERCTEST(S) HOW MANY^- � APPLICATION# <br /> >�+J <br /> SEPTIC TANI TYPE/MFG(-7J)Yc CAPACI"IY .42-00 #OFCOMPARTMENTS� <br /> !/❑- GREASE TRAP TYPE/MFG ""�� CAPACITY #OFCOMPARTMENTS <br /> LlPKGTX PLANT DISTANCE TO NEAREST: WELL,�'r FOUNOATION.,� PROPERTY LINE I&a / � lV-) <br /> LlLIFTSTATION SIZE - TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) VI <br /> �C� F / <br /> al-f LEACH LINE k OF LINES: LENGTH OF�F LINES: o6TANCETONuxcer: WELL FOUNDATION LcJ PROPERTY LINE <br /> (/ � INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH oLR.4NLITONEA w. WELL FOUNDATION PROPERTY LINE n <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIRT CF.TONEARL.T-. WELL FOUNDATION PROPERTY LINE f <br /> ❑ SUMPS WIDTH LENGTH_ DEPTH DWTANCETONLARcsr-. WELL FOUNDATION_ PROPERTY LINE ) <br /> ❑ DISPOSAL PONDS WIDTH) LENGTH DEPTH DI.TTANCITDNIIARIST: WELL FOUNDATION PROPERTY LINE <br /> SF.F.PAGE PITS # C. DIAMETER! .111.ZS 1 W.W.TDN[MPar: WELL/ FOUNDATION 2-4 PROPERTY LINEI -0- <br /> 1 HEREBY CERI7FY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCE&STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI ' M 2 H V ICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)469-3/21 <br /> SIGNED: TITLE: DATE: 5^d L <br /> I <br /> —t' <br /> ....... ..... <br /> —�- ' Aid I <br /> — <br /> --+--- -� �'I�` � -�r---i-?—T-t-- _._ __..... �- I --•--1-'—� j— PU;LIL[�'''Fi� IVY 101 <br /> J I <br /> DEPARTMENT S - ^^ !� <br /> APPLICATION ACCEPTE BY'. �D1ATE: REA �EMPLOYEE IDM' ))`' ISiRI[7LOCATION <br /> INSPECTEDBY: DATE: �/. PERMITFINAL YES DATE: /401-4-INSPECTOAZ- <br /> COMMENTS: 44,.6IP Il-?1-Vz 1 r& Ili5(1-- ive>T K&4D9fol,jv54o+1-2 1 isms I2& <br /> PLCUOL SCINFO AMOUNT CHECK ASH RECEIVED DATE PERMITfSERVICE REO Tt INVOICE• REITK'TDF <br /> REMITTED BY i <br /> q213 a,L a �51eoajl930 i <br /> „ <br /> REVISED R-I!-01 � - <br />