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10/05/2004 15:25 4640138 ENVIRONMENTAL HEALTH PAGE 02 <br /> cc LIQUID WASTr ?Fpm <br /> SAN.InAOUIN COUNTY Puj3LIC MGA).TH SERVICES%W*ONMENTAL HEALTH DIVISION <br /> ;1Da F.WEDER AVE 3 FlOOR.,STOCKTOr4-CA 95202(21%))4eK-142D <br /> 3 NON. ABLE. R T EXPIRES 1 VF.AR FROM DATE ISG II:1� n <br /> — ArN� _ rARCF.i.SIZF -7 <br /> JOB ADDRESS—i—7 ' ^` <br /> C <br /> vs- <br /> RUILDING PERMIT R (J <br /> D SG <br /> OWNER NAME - ��� ADDRESS----- <br /> PHONE NUMBER_ <br /> r - CIT\'17.Ir •--- �I[�/J /Ln� ✓ 7 <br /> CONTRACTOR <br /> PHONE NUMBER/ <br /> clTv(zlr ...— <br /> Y TOWNSIIIr__RANGE- SECTION <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X ... ---- - <br /> INSTAI.LATION WILL SERVE: NUMBER OF LIVING IJNI'T'5:� — <br /> TypE OF SEPTIC WORK: 2 <br /> X NEW INSTALLATION 10.RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMCRCIAL NUMBER OF EMPLOYEES: <br /> ❑ DP_STRUCTION ❑ OTHER_ <br /> -.- <br /> 0 rNOINEERCD/ALTERNATIVR p �7/ <br /> _ CHARACTFR OF SOIL TO DEPTH OF 3% <br /> T/SUMP SOIL CHARACTER: WATER TABLE DFPTH: (L_ <br /> [] PERC TEST(5) HOWMANY APPP1•LICATIONLl1_ — <br /> .SEPTIC TANK TYPFIMFC D.�- �Z=-, J CAPACITY 7-f'--IJ k OF CAMPARTMFNTS_� <br /> _ CAPACITY k OP COMPARTMENTS <br /> Q GREASE TRAP TYPEIMFC / /' / <br /> ❑ PKC:f'%rLANT DISTANCE TO NEAREST: WELL—L--2- <br /> FOI INDATION�Q_ PROPF.0.TY LINE- ' -r- <br /> ❑ LIFT STATION SIZE TrrE OF NIMP_ SAND OIL SEPARATOR(ENCLOSED SYSTF.M)_ <br /> LEACH LINE MOF LINES:, <br /> I.F.NGTH OF LINCS:-11--l�)' DrvTANCR TO I-ARYAT: WELL�Z�/ rOLINDATION � PROPERTY IANE <br /> ao <br /> INFLITRATOR CHAMBERS: /n Y�bt-^ ` <br /> ❑ FILTER RF,D WIDTH LENtTTH DEPt'H <br /> DlRrnnCP To nEARRCI': WELL— POUNDATION PROPERTY CINE C <br /> WIDTH LENOTH DEPTH nIRTANCE rD NCAREKT: WELL_ <br /> FOUNDATION ►ROPERTY LINE <br /> ❑ MOUNDED <br /> mcrANR TO NFARLTT; WP.LL FOUNDATION PkOPERTY LINE <br /> r, WIDTH LEN(ITN DGPTH �- <br /> ❑ 9UMP5 <br /> LENGTH DEPTH n�'ANR TD NF.Afl6FT: WELL— FOUNDATION PROPERTY LINE. <br /> ❑ DISPOSAL PONDS WIC - <br /> FOUNDATION PROPERTY I.INE2s <br /> SEEPAGE PITS p <br /> -O/� DIAMk7RR OP.rTH PttT'ARR TO NFARGiT: WP.I.L <br /> a. I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPI.ICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN('OUNTY ORDINAN(:M STATE LAWS N <br /> AND RULFS AND REGULATIONS OF RAN JOAQUIN COUNTY, <br /> MINIMUM, OUR ADVANCE NOTICE REQUIRED FOR <br /> ` ^^INSPIECTION - £CALL(209)""-3429SPDATE:� Z 7 <br /> TITLE. � , <br /> ra SIGNED: <br /> HES nes, <br /> _. - <br /> I , <br /> : <br /> DF.PARTMF.NT Ii (�O �y Iy/- -y)�_', <br /> .LEMPLOYEE IDN LOCATION_ <br /> APPLICATION � \��\ ,���IIII�y� J PF,RMIT FINAIvVs DATE (O�NSPECTOR <br /> rFRMII'/56RVII:E REQIIESIN <br /> kCMITTEU INVDICEn SlPTIC IDM <br /> :� rE l'ODF. 9C INF(1 AMOUNT CHCCKA NH HSCUEI D DATE. <br /> e o03��9z <br /> ZD 7 <br /> '+' REYI:ED LISYI <br /> 10/05/2004 TUE 14:57 [TX/RX NO 76101 Q003 <br />