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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3F°FLOOR,STOCKTON.CA 95207(209)46%-142D <br /> ((/��/((.. OM1 REFUNDABLE TERM17'EXPIRES I YEAR��IFROM DATE ISSUED //�� <br /> JOB AUDRh:SS_ _! - `-__�� O APN DidT-170.2 a, PARCEL 517.E:__G�+�/~ <br /> CITY/ZIP 7��� f�CQ IN ���a Vl BUILDING PERMIT III— - _OWNER NAME <br /> CITYf3�- �OU�TON �t'��07 PHONE NUMBERD �P.�y,�,y 7 - ' <br /> CONTRACTOR_Lfl.�v CI�,P7E^�/!�V ADDRESS_ I -D�+��-/nom (3-71,4 <br /> � " 1,4 <br /> CITY/7JP ���(2(J��. L-A '/��r/ PHONE NUMBER�(��T/-14103 <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X Y - _- TOWNSHIP - -RANGE SFCTION <br /> TYPE.OF SEPTIC WORK: IN5MIJ.ATION WILL SERVE: NUMBEROF LIVING UMTS:_ <br /> O NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIILADDITION O COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION O OTHER _ <br /> O ENO INEERED/ALTERNATIVF <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTI I: <br /> PERCTF_SF(SI HOW MANY r-2, APPLICATION# <br /> ❑ SEPTIC LANK IYMMFG -. _ CAPACITY _ 4 OF COMPARTMENTS _ 4-1 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY _ _ #OFCOMPARTMENTS -.tW� <br /> ❑ PKGTX PLANT DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE ,!h <br /> ❑ LIT STATTON SIZE- TYPE OF PJW ._ SAND OIL SEPARATOR(ENCLOSED SYSTEM) W <br /> 2 <br /> ❑ LEACH LINK. #OF LINES: LENGTH OF LINES: DWTANOETONEARTbT: WELL FOUNDATION PROPERTY LINE <br /> ]NFL)IRAI OR CHA-MEIFRS: 1E <br /> O FILTER BED WIDTH LENGTH DEPTH__ DIATANCE40NFARENT; WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DfbTANCZ TO NEARGST: WELL FOUNDATION PROPERTY LINE— <br /> 0 V <br /> ❑ SUMPS WIDTH LENGTH DEPTH DItTANCPTTIN ftm: WELL FOUNDATION PROPERTY LINE C <br /> Cl DISPOSAL PONDS WIDTH LENGTH DEPTH 0WrANCET0NEA 4M WELL FOUNDATION_ _ PROPERTY LINT <br /> ❑ SEEPAGE PIT'S # DIAME:LR DEPTH DISTANCETONFAm— WELL FOI:NDATION PROPERTY <br /> 1 HEREBYCERTIFY THAT I HAVE PREPAREU THIS APPLICATION AND THE WORK WILL BE DOPE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCESS,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)468-3423 V"1 <br /> ✓ vZ 1 <br /> SIGNED: _ I _ TITLE: S`t/NER DA'N'E: 7 '1- <br /> -�-- - --I_ - -- - .-J— <br /> . I <br /> _ I ! <br /> I— - - — _ <br /> DEPARTMENTus� E ONLY <br /> APPLICATION ACCEPTED BY: OAl"E: AR F.AEMPLOYEE ID91�gq DISTRICT-2—LOCATION-qf <br /> INSPECTED By:---_ - _ BATF."_ PERMIT FINAL.0 YES DATE:_- __INSPECTOR: <br /> COMMENTS:__ -.-- <br /> PECODE SC:NFO AMOU1 T CHECKS O RECEIVED DATE PEdMIT.SFRVICF.RF.OUESTA INVOICE' SLM IC IDA <br /> ;EMIL'FD Bl' <br /> Zl-L 5Zj 9 /SSS 9/0 C ko 34 415- 61-35' v <br /> REI ISED A-14AI <br />