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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUJILIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> ..yr 361 E.WEECR AVE 3"D FLOOR,STOCXTON,CA 95202(209)469-1420 <br /> o -1 T� NUN-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE IS/SUED )� <br /> �' JOB ADDRi.SS e/fTJ"lT L,� l �C 2 � APN 'r �60 + PARCELSIZE:�y[���Z <br /> CITY/ZIPf/- ^`� t d/J Cr� RUILDINGPERMITN jl//T <br /> OWNER NAME-, L G ADDRE55 4_n� /} `1y,�--I <br /> CITY/ZIP - (j�],.t{/^/I{/ �/I i/ 1 PIIONE NUMBER C/ u 7 <br /> ,- <br /> CONTRACTOR ADDRESS!�L C-i t �F��"` ADDRESS 6 s <br /> -76 L�PNONE NUM1IBER �, r ( Cj __ <br /> GEOGRAPHICALINFORMATION:COORDINATES. X - ..Y TOWNSIIIP RANGE SECTION <br /> TYPE OP SEPTIC WORK: �I[�(STALLATION WILL SERVE:.. ,', fi I I•.� NUMBER OF LIVING UNITS:. <br /> NEW INSTALLATION /[]I RFSIDENCF. -I`•+ �_ NUMBER OF BEDROOMS: <br /> ❑ REPAIRIADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES; <br /> O DESTRUCTION CJ OTHER � I,�!j <br /> ❑ ENGINF.RRF.DIALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3':_ PIT/SUMP SOIL CHAWATER TABLE DEPTH. <br /> ❑ PERC TEST(S) HOW MANY !!__ APP�L�ICATIO((�)N��,,R <br /> SEPTIC TANK TYPE/MFG_ -FTf� �. 1WC/LC�I� CAPACITY Z�C7 MOFCOMPARTMENTS� <br /> ❑ GREASE TRAP TYPF./MFG CAPACITY NOFCOMPARTMLNTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION t'ROFERTY LINE <br /> ❑ LIFPSTATTON SIZE TYPE OF POMP SAN OIL SF.PAR ATOR(ENCLOSED SYSTEM) <br /> / f <br /> It. LEACH LINE #OF LINES:_O LENGTH OFLINL'S: ?� oaTANCR TONUR[e'r: WELIl Otl FOUNDATION O PxOPERTY LINE <br /> r INFt,ITRATOR CHAMBERS, <br /> F'ILT'ER BED WIDTH LENGTH DEPTH-_ DISTANCRTONTARRRT: WELL FOUNDATION PROPPRTY LINE___ <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DLtTANC[TONG CFt, WELL- FOUNDATION PROPERTY LINF, <br /> !r / T 5 <br /> qQ SUMPS WIDTH__`-'t__- LENGTII�� DEPTH oaTANCc 7o N[ApisT: WELL FOUNDATION PROPERTY LINE <br /> (❑I DISPOSAL PONOS WIITIH \ LENGTH DEPTH DI[TANCETONTABUT. WELL FOUNDATION_ PROPERTVLINE <br /> ❑ SEEPAGE PI.13 11 INAMF.T FR UEPIN DLRANC[TD NEARCR= WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAV - SPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULE.$'AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> UM R ADV <br /> MIIyjMANCE NOTICE REQUIRED FOR INSPECTIONS-P�LF:AntiE ALL(2119)/be-347J ! <br /> SICNRD: V.:) TITLE:Gou. r-j-nt--DATE: f'Z <br /> , <br /> 1 <br /> o a 1 av r C a- <br /> _1_ <br /> y� <br /> , <br /> 1� <br /> - <br /> - - --- <br /> i <br /> I � I <br /> J.4.. !_.._ <br /> I <br /> I� } <br /> , I <br /> : <br /> 1 I <br /> 4 <br /> : <br /> I I I <br /> Oct TMENT 49EONI `1 <br /> / <br /> APPLICATION ACL'E fD B O• �AREA�EHPLOYEE ID4 ���I'''/7 <br /> DISTRICLOCATIO\V <br /> err Y LE! <br /> INSPECTED d -� �'' / ___ DATE: '-'�� �'"z- PERMIT FInAi:1> VES DATE: - INSPEQ'r <br /> COMMENTS: <br /> I..CODE SC INTO AMOUNT SH RECEIVED DATE PERMIT•SERV:CE It UESTI' INVOICE, SEPTIC IDN <br /> REMITTED BY <br /> �- � I_ 100 4A.a I "It-116 9 <br /> REVBED 415-0I ca-o 3q a3 <br />