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LIQUID WASTE PERMT' � <br /> SAN�'JUIN COUNTY PUj3LIC HEALTH SERVICES ENVIRONMENTALNr1LTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)469-1420 <br /> N REFUNDABLE;PERMITEXPIRES 1 YEAR FROM DATE ISSUED <br /> d)R AUURF:SS • _ APN c —I O PARCELS <br /> I%F.: <br /> CITYPLIP BUILDING PERMIT 0 <br /> r ADDRESS--a <br /> OWNER NAME ,,QQ <br /> CITYlZIP��T._ PHONE NUMBER <br /> '\'.ArG]��' ,mac ✓��J ���-- ADDRESS Z,� <br /> CONTRACTOR I '� <br /> CITY/ZIP l!%CI� `.'/�1 �D <br /> PRONE NUMBER V`0� ✓'� ` / <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y_ TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: / WATER TABLE.DF.P"Ill: <br /> JI�I PERC TEST(S) HOW MANY APPLICATION# <br /> \❑ SEPTIC TANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE �\ <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE ) <br /> "\1 <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONFARE.ST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEARFNT: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE.LA WS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-.142.1dl,q �J <br /> SIGNED, ( 10G TITLE: /�fo�I,�t DATE: <br /> I ..�. . ........ .... . } } <br /> ' ..... __...{. i...__.. 4 ......y .. .. ___ <br /> �...... '............III ... �... ... ' ' � <br /> i.. <br /> } <br /> .. . ........ , l ; <br /> f <br /> 1 ! 1 <br /> ._ $. a ............ . . ............ ... .... _...... ; --f t _;_ 1 �..._' f . f._ <br /> } . <br /> ... .......... .... 1 ....... } .......... .. .........L............_._,...... } ,....... , t - <br /> .... ...... ;....... ... f <br /> : <br /> 1.._. a �.._. . .. ...�... ... ....... . i... ......._.: . <br /> ... .. .. . <br /> .. <br /> ._. . ... . ........ ...... <br /> 1.. ........ . .. �.. ,.. <br /> }. <br /> V\ <br /> ........ ......_-..................... .......�... .: [, a�� �0 . � rrv�+►� _fro <br /> -— ._....... --........._.. . . .........-............................................._ .....a <br /> . ... u l�� <br /> — --- —. _ <br /> fifi <br /> ....._........ .I ... <br /> { t <br /> `._.._._.._.. ___. _......... . . .... . 1 ._._� 1 <br /> i i f ......_....._.. M E { — 1 <br /> L. ._.. .. i.. - -- RECF► �E - <br /> �_ _ E - <br /> _ - - - <br /> F <br /> _ .._......I. .._... _. .. __ } �_ Y <br /> f - - . JUS . -- - ' <br /> ._.. _ ._ ;. <br /> a <br /> ._... ....... ` . _... i..... SAN JC a(�±)N l .)U. ,}_ <br /> ........... - <br /> __ . 1 ....I.. .-. �. $ { f I. f �. PUBLICHEATH�tti,h i - <br /> _ - -..,�,�-- w <br /> 1 . .�....�iVVIflON1Vl TSI NF <br /> �'�n[/ DEPARTMENT U F.C/O LY / /� <br /> APPLICATION ACCEPTED BY: G� ___. ---r__ �__.. _DATE:—_- �D--�REA�1 =F.MPLOYEF.IDM__7 Q_7 DISTRICT -LOCATION <br /> INSPECTED BY: DATE: �Z PERMIT FINAL YES DATE: ^'•-�?--lNSPEC 0 <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT 'HEC' ('ASN RECEIVED DATE PERMIT/SERVICE REQUESTa INVOICEw SEPTIC IDM <br /> REMITTED BY <br /> Ri'vlcl-n"-1c-F1 <br />