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LIQUID WASTE PERMI %)%wMAOUIN COUNTY PUJILIC HEALTH SERVICES F.NVIRONMENI w.4I:AI.TII DIVISION 304 E..WEnER AVE.3"FLOOR,STOCKTON.CA 95202(209)469.3420 NON-REFUNDABI,F PERMIT EXPIRES I YEAR FROM DATE ISSUED _ t / C� • PARCEL SIZE: JOB ADDRESS ) Z CITV/ZIP G-{(,r1T v r/)�' / Z. C,� BUILDING PERMIT If L l L OWNF.RNAME J �( 11 -f�/ ILC ADDRESS �l \ -"-A CITY/•LIP �t •- t�'�— _ PIIONF. NUMBER i / 1� CONTRACTOR i✓ ti � `) L( ADDRESS ` ?l..% ` CITY/ZIP l I I ? PHONE NUMBER GEOGRAPHICAL INFORMATION: COORDINATES: X Y_ TOWNSHIP/RANGE 1•' SECTION- TYPE ECTIONTYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: ❑ REPAIR/ADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: ❑ DESTRUCTION ❑ OTHER ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: PERCTEST(S) HOW MANY APPLICATION# ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ LIFT STATION 517E TYPEOF PUMr__ _ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCETONEARE%T: WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE N ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE , r V ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ` ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 'x ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITII 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 ti1GNF•D: �� / TITLE:�- / ` r `1. DATE: !; ' 7-` .....'... :......... 1 '.......... ...j...: .....:::. l - : :.... ..._ j .......i i ... ' > ....._ _r_.._ . � a . I__...................... _ ..._.._._.._....... �....' --...... I I .. i.. .l - - JJJ . L.......;...... . . I . .�... .i. 1_ ..1. .. :.. I �.. j C t _. fi '. 1 I �_ __ _ { �_ , .._, .. ......t - _ ... .......__. ........... ------ ......_._...----. _......_..................................-'--�---................�. _ I i _.................... . 1......._I .. i _....._.i._................1.-- ...._..... ._ .... ..........................._.. .. -. _. ... ..... I F I.. } j_..... ....1...... ..._... .... .. . . _l.__... _.. __!L_._....... I I t .......` f I I� -._.._......__..._............._.__..........._............ -_._. _..........__.._..._..._........ .. ... l _ _ r ......_.... ......F_.� _.................._1_..._._.......... _._.__._........................._...... .............._.._....._....f............. 1 , f............ 3........_.�.._....._� i........-..4. j I i __f__ ...... ......... .......... _ _______.. _ . _. .. —_ , E j a _I : _..._......_._......... . ...... ......._..h........ - - — - -_...._ PAY M E N 1- .......... . .. ......_._.._._.._._..__..... .. _........;....._ .......1 ..._;.. ...... - i.....__ -- - �._ .._........ ... : i '�.i - - - ........................... )...................._.. ._......-_..._.............._. ......_.-....)....... �:_ '.....-. _.__ .. ... ... ... ... ... .. 1.._i........-r.....-_.._._ _ 1 .. .. . I.. {. , -- IN _..................._......_... ..._..... .. ..__...__...._........._S ..J . UINIC.O. N. .(......_..---.-_...._..........._.................._..........................._...._.......... ... ...._-......._........... ........................ P BLI HE LTH ER/ICC i I... ! ...... ......-FJ�LTT nv'�n...... ............ . ) (_ I �. D. ((///� DEPARTMENT U."'.ONLY l JL/ n ice! -! ►/, APPLICATION A('CEP fD RV: - _��..:.-- ' -- _ nnlr:: ('�._ / AREA—.-_-__-_-. r:MPI OYES IDN DIS rRI<'T -_--_LOCATION a INSPECTED BY: ' DATE._ —ZU�� _-PERMIT FINAL O YES DATE: INSPE('TOR COMMENTS: PE CODE SC INFO AMOI1N1 '.('KM .ASN RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# SEPTIC IDM REMIr7GU BY RF.VTSF.D N-I c_OI