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' LIQUID WASTE PERN('�' <br /> - - SAN JOAQUIN COUNTY PUJILIC HEALTH SERVICES ENVR?ONMENTAL HEALTI-I DIVISION <br /> 104,E.WEBER AVE 111"FLOOR,STOCK-t•ON,CA 95202(20)46x-3420 <br /> NON-REF-UNDARLE.PERMIT EXPIRP;S 1 YI•:AR FROM DATE ISSUED <br /> x� .IOU AvtmrS5.�) �L% `flG'y A-Z APN �� ' ..� 4... PARCEL SIZE: �)7// <br /> C'.ITY!Z€P ��` i BUILDING PERMIT It <br /> "OWNER NAME '-QT'" 7J 1 <br /> ADDRESS <br /> ` o' . _ _ <br /> CI'rl'1Z1P .�([` �l�f—l'X '14,1L0 PHONE NUMBER 7n <br /> CONTRACTOR �r!� �-`tel'/%C -,-f 7O,-/4f,G_. --, ADDRESS <br /> I_ C'Il'1'l7,I1' PHONE NUNIBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: R )' _— — TOWNSHIP RANGL SLC'1'IUN <br /> TVPC OF SEPTIC NVORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION 0 RESIDENCE NUMBCItOFBED1200R'IS: <br /> ❑ REPAIR/ADDITION 10 COMMURCiAL <br /> ❑ DESTRUCTION Q OTHER NUMBEROFEMPLOVEES: <br /> U LNGINECRED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH 0I7 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TFST ISI HOW MANY APPLICATION 4 <br /> SEPTIC TANK. TYPEIMFG �'/yr /Z'f�-- CAPACITY i #OF COMPARTMENTS <br /> k ❑ CREASE TRAP TYPERAFG CAPACITY 8 OF COM PARTML'NTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERIT LINE• <br /> 14 ❑ LIFT STATION SIZE TYPE OFPVMP SAND OYLSEPARATOR(ENCLV55DSYS'ILA1} <br /> LEACH LINE #OF LINES:-'yL LENGTH OF LINES: DISTANCETONEARESTELL <br /> : W • rrUUNDnTSGN LG' <br /> - ^� <br /> INFLITRA'r0]?CCHAMBERS: PROITItI'Y LINE <br /> D FILTER RCD WIDTH LENGTH DEPTH DISTANCE 10NF.ARE.S'ru WELL FOUNDA'NON PKOPERTI'LiNE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NCARE.ST: WELL1'-OUNDATION PICOI'ER'IV LINE_-- f <br /> ❑ SUMPS WIDI"li LGNGTH bEP7H INSTANCE TO NEAREST: WELL FOUNDATION PILOPGIYI'Y'LINE <br /> w ❑ DISPOSAL PONDS WIDTH .LENGTH DEPTH DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCRTO NEAREST: wEY. 1'OUNDATiON 1'RE7PIiR'F1'L3Nfr <br /> 1 HEREBY CERTIFY TI1 ATE HAVE PREPARED THIS APPLICATION AND TIE WORK VVfl,].,UC DONE IN ACCORDANCE WITH SAN JOAQU IN COUNTY ORD I NANCF,S,STATE LA R'S <br /> AND RULES AND REGULATIONS OF SAN.IOAQIIIN COUNTY. <br /> I MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-342-3 � ry <br /> SIGNI?D: r' L-G- -L' TITLE: <br /> c <br /> ....... .. <br /> _ 1 <br /> i I I I I <br /> S' 4D'x10' CARGO IRAILER(P) 3 <br /> C \ <br /> TRUCK PARKING I I <br /> h � <br /> s I <br /> E, <br /> in <br /> N !� <br /> • 1 Si]r f. REPLACEMENT <br /> ! 1 <br /> r LEACH FIELD 3 � <br /> J DOLLARpS Y+ITH CHAIN 1. r <br /> SEPTIC EACH (P) "DUMPS' �� i I <br /> I re <br /> �- I j 11 <br /> O'x2D' OFFICE ..' I�:" a ��Lr�li' <br /> 1 ' <br /> . k <br /> 1 <br /> o. <br /> _.. 20' RATE (P) ,._ ,J �f vlj1 OY1R7VQAL'IF <br /> Lp ...... <br /> PEFiMfT/ I T11VIGE51 I <br /> ',.,. _...... ........ r 1 <br /> I1 ........ <br /> DEPARTMENT ISE oNI,V I i 4.'. �<<j <br /> AI'PUC''ATION AC'CISPT[D RY: DATE- �—AREA f I-'Eh11'LUl'EG Ib7_ I1151'RIC"C�I I-OCA'IIONIE� f <br /> INSPECTED GY:�--� ._ DAT L:� PE_RMIT FINALQJ/YE5 DATF-/ ! �Il, INSPIC' <br /> ; FOR: i�1..'-'L7i <br /> (( <br /> M CODE, SC INFO AMOVNT CIiEC !CASH RECEIVED UATF PERMITISERVICE REQUE$'1'4 INVOICEu SEPTIC IfJfI <br /> REMITTED BY <br /> 3- <br /> PLATE lY <br />