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LIQUID WASTE PERMIT ".0 ` <br /> SAN JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMENTAL.HEALTH DIVISION <br /> 304 E.WEDER AVE 3""FLOOR,STOCKTON,CA 95202(209)4W3420 <br /> \�/!�J [��" NON•REFI! ABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED �4f"✓ d <br /> JOB ADDRESS-_.���J �./ C.i - cu APN /83 `I(T D 4PARCEL SIZE:j&C`5 <br /> CITY/71P c L, BUILDING PERMIT N 04)"' 3 0 - <br /> OWNER NAME `� og, �+-II,G ADDRESS <br /> CITYfLIP PHONE NNVMBBER -� <br /> CONTRAC.TOR_1 \.(���• , ` ADDRESS � <br /> I <br /> CITY/ZIP _ PHONE NUMBER_ 3A 6 ^ 3 <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X- Y-- TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: _ <br /> W❑ EW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS- <br /> REPAIR/ADDITION OMMERCIAL / <br /> ❑ DESTRUCTION NUMBER OF EMPLOYEES: Y� <br /> E3EN(i1T3EF.RF.D.'AI.TF,RT�ATIVE ` n C <br /> CHARACTER OF SOIL'I'U DEPTH OF 3' l3G PIT/SUMP SOtI.CHARACTER-.% y SfI� � WATER TABLE DEP'T'H: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# 2 , <br /> \V-SEPTIC TANK TYPE/MFG CAPACITYa��o �-4/#OF COMPARTMENTS. <br /> /❑vGREASETRAP TYPE-'MFG _-... CAPACITY #OFCOMPARTMF.NTS N <br /> nn r <br /> \❑ PKGTX PLANT DISTANCE TO NEAREST: WELL-,040 •f FOUNDATION/0,0 /� <br /> PROPERTY LIN�� <br /> T -LIFT STATION SIZE ARr;� SED SYSTEM <br /> IlF . w <br /> I.FACH I.IVF. (!OFLINES: LENli1'IIOI'LINES:1�70DISTANCETONEARCST: WELIi `f FOUNDATION /00 /�ROPERTYLINT C <br /> INFLITRATOR CIIAMUERS: 1 <br /> /// <br /> ❑ FILTER BF.D WIDER LENGTH OCPTII DISIANCE'fONCAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCR•IONIARY.\T: WELL FOUNDATION_`__ PROPtR1YLINE <br /> ❑ SUMPS WIDTH LENGTH CAPTH DISTANCETONFARES'T: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DF.PTN DISTANCETONF.ARECT: WELL FOUNDATION PROPERTY LINE <br /> I <br /> (JyV ,. DTANETUNEwRETC : WEUC�?.O i FOI/ SEEPAGE PITS 40 DIAMETERDEPIN-0 INDA7'ION� <br /> �� <br /> PROPERTY LINE Z <br /> HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BF DONE.IN AC.CORDAN('F.WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI IJN1 24 Fj UR ADVANCE NOTICE REQUIRED FOR IN%PEirTIONS-PLEASE CALL(209)469-3423 `' <br /> SIGNED: TITLE: ' DATE.: 1 jjV-/, -a <br /> I <br /> t . <br /> -F-- - -j'--�---� - - - I - I JT <br /> —�--� -- - <br /> _ �I <br /> �r 1"F.e4xl <br /> �T ( I ARE <br /> -s�,Iv eBu - , <br /> — -- - - -- --- -- ---I - - -- <br /> ' N r3UGH <br /> I NVt�tONIAEN fiEA l H�lU - <br /> DF.PARTMEN7 USE ONLY II }4�� <br /> APPLICATION ACCEPT D DATE: ..iAREA �I� EMPLOYEE IDA A/3DISTRICT L C I-IONq <br /> / -,I� o /may <br /> INSPECTED BY: _ 1111 _ _`}1_- d1,` f1��( 1',�1t(h DATE: `t�q v t PERMIT FINALI� YES�DtA�TE: ~�SYECI'ON: a <br /> COM,,ME�h:S' S �1I-Wa •+upli/.a_wj i. biio+A e- Id•ZZ•C � AC L_1VC7 Epl SMSU D1 Ic7� <br /> 10 7LT_. v5 �, ;1K Powao j A Y TJfNK 1Nb o 1 Yle4'r1la" fjOARoUED #i R �7� �A"k$S/o-WS <br /> �� <br /> I•L l'OUL SC INE U I AHULN I ECKM/C H RECEIVED DAI E --/ 'E REQU•ES IN INVOICE" S.LI•TIC IDN <br /> RPMIT:EII By <br /> REVISED&I."I <br />