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LIQUID WASTE PERMI .S FF I C <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DhISION <br /> 304 E.WEBER AVE.,31°FLOOR,STOCKTON,CA 95202 (209)4()8-342(f <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> �.//����`fV /�-I 1 n q <br /> CITYIZIP !~lJr 1 PARCEL SIZE/APN 01 ! r�`-' U�' <br /> OWNER NAME ADDRESS twi W u ls G <br /> 1 <br /> PHONE <br /> CITYIZIP �►,, t.��p/�,� <br /> CONTRACTOR_$,I G-,yL��Y.� - D � �I�!�• lll� .�ADDRESS �/y�� (� _��(� <br /> CITYIZIP LJYE. PHONE �"1' + �rr�'/�� {{ <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIPW 4 RANGE-VSECTION f <br /> PERC TEST(S) O•-HOW MANY APPLICATION Ii:_ <br /> TYPE OF SEPTIC WORK: C3NEW INSTALLATION ❑ REPAIRlADDIT[ON ❑ DESTRUCTION gl <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL <br /> MOTHER -fP- <br /> ii <br /> NUMBER OF LIVING UNITS: •'�. NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH + <br /> ❑SEPTICTANKIGREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS 1 <br /> fl <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE �.J <br /> ❑FILTER BED WIDTH _ LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH .1 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE- <br /> El SEEPAGE <br /> INE❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> i <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY t n <br /> ORDIANCE STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �" DATE: !� <br /> SIGNED: A. TITLE: � <br /> I <br /> i <br /> i <br /> I <br /> rr■r�� <br /> rtvrarive.war <br /> oouex -xi soy-+-si i <br /> r sF.t Or" <br /> Wxl Can4 i.if+ <br /> ,.-,.. w,. ai S.x:O.Gvi•CGS+1•e6 a u. _ <br /> f- <br /> ..._- <br /> -T- <br /> ., ...� x x�i six G.. <br /> ro �.•n' i <br /> it <br /> ' i ..,. -`y it .:.,., _4xr"• -- <br /> ub <br /> NAPS I %r��. �f fl p <br /> iiVt �1 1 SITE, <br /> • <br /> TE'T <br /> Aecewrtl gy U/f <br /> O <br /> I I <br /> 'O IIEPARTMEN'I'USE ONLY <br /> %D SIGs/ <br /> APPLICATION ACCEPTED BY: - DATE: <br /> 141I�d <br /> TANK,PIT,OR SUMP INSPECTED BY: ! DATE: 7�I <br /> FINAL INSPECTION 13Y: <br /> M —0 <br /> COMMENTS: �C <br /> PE CODE SC AMOUNTCHECK# RECEIVED BY DATE PERMITISERVICE REQUEST'# SEPTIC ID# y <br /> f INFO REMITTED CAair <br /> X225,21 L6 <br /> °E1 rO/y�p 5' oda C�(a-�/ <br />�I <br /> C� <br /> I <br />