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LIQUID WASTE PERM � <br /> it JAQUINCOUNTY PU.BLICHEA LTH,SCRVICES ENVIRONMEI HCALTHDIVISION <br /> _�... 304 E,WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(20, AR-1420 <br /> RF.FUNDARLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB SS 8� v r r1 APN 5- <br /> 260 <br /> CITYIZIP ZIP � -« t'`e�! <br /> BUILDING PERMIT# <br /> 'B <br /> OWNER NAME�C I �y7y <br /> .. .. ADDRESS_.E?>6 <br /> CIT <br /> YIZIP ' 195-336- P}ZONE NUMBERAft <br /> CONTRACTORA �� ' ADDRESS 1�1 V WAY <br /> CITYI7,IP S ICA C)�M5 PHONE NUMBER <br /> : y <br /> GEOGRAPHICAL INFORMATION: COORDINATL•S: X Y TOWNSHIP RANGE SECTIGN <br /> I - I <br /> f <br /> TYPEOF SEPTIC WORK; INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:� <br /> NEW INSTALLATION RESIDENCE <br /> ,� NUMBER OF BEDROOMS: <br /> C1REPAIR ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION �! LI OTHER NUMBER OF EMPLOYEES: <br /> I <br /> ❑ ENGINEERED/ALTERNATIVE. <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: <br /> .:p WATER TABLE DEPTH; <br /> ❑ PERC TESTS) HOW MANY 11 `f APPLICATION# <br /> SEPTIC TANK TYPE/MF -G {II` c CAPACITY #OF COMPARTMENTS. <br /> ❑ GREASE TRAP TYPE/MFG �! CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO !�NEAREST: WELL-10C+ FOUNDATION PROPERTY LINE '— <br /> ❑ LIFT STATION SIZE § TYPE 0E rUMr SAND OIL SEPARATOR(ENCLOSED SYSTEM) r <br /> Ih � T i <br /> LEACH LINE #OF LINES: ..� LENGTH OF LINES: { f��'� ��j '36p� <br /> DISTANCE r0 NEAREST: WELL �+ FOUNDAT1ON�.e �i i PROPERTY LINE L!t!+ <br /> E--{}7C-7 INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH i. LENGTH DEPTH DISTANCE TONEARE.ST; WELL FOUNDATION PROPERTY LINE <br /> I <br /> C,] MOUNDED WIDTH j' LENGTH DEPTH DISTANCE TONEAREST; WELL FOUNDATION_ PROPERTY LINE <br /> © SUMPS WIDTH II LENGTH DEPTH DISTANCE TONFAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH -LENGTH DEPTH DISTANCE TO NEAREST: WELL -FOUNDATION PROPERTY LINE— <br /> SEEPAGE PITS # DTAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS `' I <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI rjMUM 24 HOLURADVANCE NOTICE REQUIRED FOR INSPECTIONS- L 'ASE C L"(209)468-3423 (( ^� [� <br /> SICNEU: <br /> 'j TITLE DATE;A! -7102 ' <br /> I <br /> ...._ <br /> i>S JI ��r✓ v Fc . <br /> 9 <br /> i <br /> M .. <br /> ��... <br /> I �r <br /> ,. <br /> ... . <br /> , <br /> Ips. o .,,, <br /> I <br /> �t .. 1 5x,1 <br /> _ � ....... � T. P <br /> I� ......... 0 o�e o i o f ,'`b41 <br /> .. . <br /> II � I I <br /> �-. r _ <br /> : <br /> .,..,"4 <br /> P <br /> t <br /> GPA-v1:1-1- Rbc e <br /> v 13� <br /> 1 <br /> N <br /> � t " L_j_qAPPIICATIONA 8Y: ISEMPLOYEE <br /> IDk �"" DISTRICT + LOCA7-ION�� ` <br /> ,h Y <br /> INSPECTED _z _ ` -_--�DATE:�� /�"� PERMIT FINALk7 YES DATE: *6jry,�-,INSI'ECI�OFt1�✓ ? <br /> tj <br /> COMMENTS: /� <br /> PE CODE SC INFO AMOUNT III CHECK alC SN RECEIVED DATE PERMITISERVICF.REQUEST# INVOICEa SEPTiC IDH <br /> REMITf E[] I BY <br /> A C-0 319 4-3 <br /> I� <br /> RF.\'f.SEU x-IS-01 <br />