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LIQUID WASTE PERP " r JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONML HEALTH DIVISION 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)468-3420 J I /l� N . NON-REFUNDABLE.PERMIT EXPIRES�Epjt f Ijjl� 1TF PARCEI,SIl.E: JOB ADDRESS L �/• Q //�� APN r� C-ITV/ZIP 1J 1 r� /526 3 BUILDING PERMIT# �1 01 'Dog I� � OWNF.RNAME %MN UAWPPOr L` ADDRESSPO UIX n lJ CITY/ZIP DoaAtq D Mf' __ PHONE NUMBER 16-631-3520 CONTRAC(TOOR- A PI'S M "5 14 ± VV/r,� 1`�SWS; ADDRESS4- W(LSW NOWCITY/ZIPS I_DC(4J aJ 1 135Z5 PHONE NUMBER 466 I GEOGRAPHICAL INFORMATION: COORDINATLS: X 1' TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: xNEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: ❑ REPAIRIADDITION X COMMERCIAL / L3 DESTRUCTION ❑ OTHER NUMBER Oi EMPLOYF,ES: �j =(�U�fDt�tCcGS ❑ ENGINEERED/ALTERNATIVE &Mp�oyE�'S CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL/CHARACTER: WATER TABLE,DEP I'i1: ❑ PERC TEST(S) HOW MANY ` / / APPLICATION# �T/ `, t Cf/� SEPTIC TANK TYPE/MFG-6 V (l _ CAPACITY= #OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG _ CAPACITY y� #OF COMPARTMENTS T ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION 104" PROPERTY LINE 10+- ❑ LIFT STATION SIZE TYPE OF PUMP____ SAND OIL SEPARAT,�.1ORR(ENCLOSED SYSTE1M) xLEACH LINE #OF LINES: LENGTH OF LINES: 6� WSTAIVCE T.NEAREST: WEL6,9-4- FOUNDATION ` O� PROPERTY LINE 'V INFLITRATOR CHAMBERS: :21 ►_�� ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCF.TONEAREST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEARF.ST: WELL FOUNDATION PROPERTY LINE__ ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE__ Cl DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE___ _ tl � L SEEPAGE PITS # DIAMETER DEPTH S DISTANCETONEARLST: WELtM FOUNDATION��+ PROPERTY LINE___ 154 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WK ITTH,SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. i INI U 1 NCE NOTICE REQUIRED FOR INSPECTION.'- 'ASE C LL(289)468-3423 �j 1 SIGNED: TITL DATE: I✓D V i i ! I ' i I i __....._......_..-- _- ...._ _._...._........,..._.._....................................._........-................................_.._........_.........._..:........_........._._............_i..................._.................'......................................'............�...... t I 1 ) t t .. i..........._ I1 1 , ......................... 1 .. . ' } 1 I .._..._..... i . _ ...1..........._.........t. ._�....._.._...................................... r.._.._. ..............................' ..........�. _i_...._�_._._._._._........._.t..._............. i } t_ !_. .,._.._........_.. w....... ..._I....._..... 1 1 U V _ ... S �I7A� i. . Bei ...a._._. �_.._._._ ; «� �._ �. - �.._._.. -....._....-.-- t----� - - ff .. .. _ i ' _ ' I , i..^ L.._.._�..: Puke , : I +...-._ _ .. _. I i _. ......._._...................._................_._..._.}_...................._�...__...._..........f- ...._.....__...._....._._.i.._..._......_.................�._........_..._......_.._._,........................_.._._.1.--_..............;............:............�... ._ t._...._.__........�.._..._.._-�._....__� . E ... _. .............._......- — —--1— — ----- f_. , _ t....____........ . ............_.._.. _.-.....__...- ... _._._ _- ....... ........._........_._._ ,_ -- ..._...a....— — — t— --- -----.....; ..... ._ .�_._... -_...._.._.._.._.._.. ..-... ...__ + I �.. . __. .._ lip 0 _..{._.._.. .. .._ _ - - - ........... - - - - - - - .... ,. .._ ._...._�........... ............. ..................._.......... - -� -- -.. i_....... ..... ......_ _. j N}..O.. t, fN!�� I I -... .... . P I NE IV 1011 f 1 }} ........._.......... +- ......_.__.._.._._. �..._.....'....._...__.. i......_.I_.... VVIR 1?. .._�'........_.__ .. 1............. -...._. I I DEPARTMENT UE NI.Y APPLICATION ACCE : 2��J DATE: 6-2- AREA EMPLOYEEIDN / DISTRICT ION { INSPECTED BY: DATE: Z PERMIT FINAL) YES DALE: �INSPECTOR: I COMMENTS: PE CODE SC INFO AMOUNT CHECKui ASH RECEIVED DATE PERMIT/SERVICE REQUEST# INVOIC'EN SEPTIC IDN REMITTED BY REVISED 1-15-01