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LIQUID WASTE PERMIT - SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL iH DIVISION 304 E.WEBER AVE 3m'FLOOR,STOCKTON,CA 95202(209)46h-1420 JOBADDRESS�� I S, ,^� NO -REFUNDABLEPF.RMITEXAPNF.SIYF.AR�ROMQ�TE_LSSUEDD� PARCEL SIZE: � CITY/ZIP 0 !�d 0� 0 � J , ` BUILDING PERMIT aOSC/` l J (/ OWNER NAME_IL 4 j/SlaV lj\ (O`( V-1 i -e-j ( ADDRESS_ V-P 1v � ✓' (/\D� (p 7--"S70 - CITY/ZIP .�tb.L:�)fJ ' m� ..�.�_ PHONE'NUMBER CONTRACTOR V. � JS(/� ADDRESS as CITY/ZIP— Y ^ 1�c�r . PHONE NUMBER�`i 367- 7C/1l VLA �/ tel - // GEOGRAPHICAL INFORMATION: COORDINATIS: X Y TOWNSfIIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: (3 NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: ❑ REPAIR/ADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: El DESTRUCTION ,❑ OTHER ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP IL CHARACTER!, ` WATER TABLE DEW"I'll: PERC TEST(S) HOW MANY APPLICATION# 414S VV❑ SEPTICTANK TYPE/MFG— CAPACITY # COMPARTMENTS Ll GREASETRAP TYPE/MFG CAPACITY #0 COMPARTMENTS El PKGTXPLANT DISTANCE TO NEAREST: WELL FOU ATION PROPER LINE LI LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATO NCLOSED SYSTEM) ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTA14CE TO NEAREST: WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: ❑ FILTER BED WIDTH LENGTH DEPTII DISTANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE \ ❑ MOUNDED WIDTH LENGTFI DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL. FOUNDATION PROPERTY LINE ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE - I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. INIM1.M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEEA,SE CALL(209)468-3423 �y SIGNED: TITLE:C//t�(0r)1 67 DATE: �/ D OOL-,t 371JC 01 II I . f n3# 1........................... ......._.. 1 ",lJl /fO1M -kwu G�Vb,CL ...•..._. j _............�............. rr ......... t . _.... .......... (rvou }...........�............. . I--.......:.......... .__._. ._..._..i.-------._......._.�............ .. IVii \ PE'KY .MCCf(O.9 Iill ALW i ,(a�CC i ,CL ISL .— _._ .. ........... _.............._.. _.._.. -. �- ' - t'rLTole T-.s9 431 I I �... _ .. 1 _ y� ..._._. . Ilk t......._..._..........._. __......_._..__..._........_.-........._... I - twn vrc .a.�m �..._......._ )LvA 30M _ ........ zg In 03WAWGr�N +a_.._....._....... sl MR - ......... ... t• ._ 1 ..........�..... ....__....._..�.. - ...._. .. .. .I! r ` � ......_......_.► NyN -WO.N . t �... F t....._............_.. n, _ _ — -- .... ... .. _ ... .. ... ..Vv 4 I ....._._..__ l ...................._ - j' , t..._..i .._..__.I_..._._ ....._.._.... ._�-- .. 1 �.:-�• ._ V II 3• 1p1G1 I -_ .. _._._.l._..._..UVAUd 30M o I ! I ,OL YEAdUtld i ..._ ...__—. on�aull n 1 I �_......�.. ( _....__. .. uQ jCW-AT't y •ip•C I ,LD'ILY I I -.__ _.. .__...L..__... ��_-. _._ .. _14' f)14 F IAL...,.._......................._...... I (r> (a).tessu W1i•saLl l 3di7.aL00N _......... ......... ........_.._..._..._... _._.._-................ DEPARTMENT USE ONLY ��/ w•.9 APPLICATION ACCEPTE BY:_ DATE: /_��C�[ - REA�/ EMP�LOY'C�E IUa_Z L/ TR ICT��LO�C�ATI`ON T IN ED BY: �rJv/Cts r DAT j�-'6,9--111 PERMIT FINAUld I Y�ESTDA�TE: O IN✓'ry0 �.rglT co J? f r?C- r ,/�/ �'�J a ai i� fo -' P5 CODE SC INFO AMOUNT "CHECKWC H RECEIVED• ,DATE PERMIT/SERVICE RE UEST# INVOICE# SEPTIC ID# REMITTED BY 16(04-3 —TW` LQ u "0 0 REVISEDR-IS-aI-� '�. �)� ,6a (. c��.�✓, .