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LIQUID WASTE PERMIT <br /> 33 SAN JOATJUIN COUNTY PU13LIC HEALTH Sf.RVI(,,C:S CNVIRONMFNT AL HP.ALTH DIVISION <br /> 1 ^•y� 3M E.WEDFR AVE 3•"FLOOR,STOCKTON,CA 952()2 I20p1 a(JI..14W <br /> • •y `� F NON-RP.FUNDABLE PERM) EXPIRES I YEAR FROM DAT 18CUED <br /> JOB ADDR.---/ p..� "" ,C j- r <br /> 1+..�� <br /> 0TvlLIP_- + U N .._ ___ BUILDiNC PT,RMIT e '620 <br /> OWNER NAME- � G�.' .[� ADDRESS �i7•G �� � 1�.�Z•-�Y i` (J/1� fwd <br /> •, f <br /> PHONE NUDtRER._........__ <br /> CONTRACTOR` - t/r�l <br /> CITlIZJP— PHONE tiUYBER 4F� /� <br /> GEOGRAPHICALINFORMATION! <br /> COORDINATES s _ Y _ - TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVINC UNITS; <br /> ❑ NEW INSTALLATION jx RESIDENCE <br /> REPAIWADDITION COMMERCIAL NUMBER OF BEDROOMS: <br /> ❑ <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENOINEERED/ALTRRNATIVF. <br /> CHARACTER OF SOIL TO DEPTH OF 3'a__ PIT;SU:MP"Oil.CHARACTER: <br /> WATER TABLE UEP'TH: <br /> • U PERC TEST(S) HOW MANY I APPLICATION d_ <br /> Q SRPTICTANK TYPPIMFC _ CAPACITY �•�,J #OFCOMPARTMENTS 4;4 <br /> ❑ GREASETRAP TYPE'MFG CAPACITY--- <br /> #OFCOMPARTMENTS__ ,I} <br /> ❑ PKCTX PLANT DISTANCE TD NEAREST: WELL- FOUNDATION <br /> PROPFRTY))NE_ <br /> ❑ LIFT STATION SIZE tYPE�Ff MP -- P- <br /> • ! .. ........... SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE. #OFLINES: 41 LENGTH OF LINES:_ r7— <br /> DISTANCL NNEARCIR; WELL FOUNDATION l�J�" PROPERTY UNE r <br /> ' INh'LI'CRATOR Cl[AMBERS: � ?y �+1 <br /> ❑ FILTER SED WIDTH LCNG ICH DEPTN <br /> Dl'i.NCLTO NLARFfi: Well. FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGT'ii DEPTH WUNUATION <br /> _.. DIR m"TO NN.RIST: WF.II. PROPERTY UNE <br /> ❑ SUMPS WIDTH LENGrH DEPTH gRTANC[TO wEARFAT. WELL <br /> F FOUNDATION PROPERTY UNE <br /> {{{I[[[ ❑ DISPOSAL PONDS WIDTH _ LENOTH DEPTH___ D M• T Njt.KL"! WELL FOUNDATION__ PROPERTY LINE <br /> ❑ SEEPAGE PIIS #_. _- DIAME'CLR 11LPTH DI.SI•MCi TONW[cl': WELL_,.__ <br /> FOUNDATION PIHH4JI?Y UNE <br /> 1 HERFBY"CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORX WILL BF DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> - AND RULES AND REGUI.ATIONS OG SAN JOAQUIN COUNTY. �V <br /> P NIM"24 H r R ADVANCY OTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)46"423 <br /> rZ <br /> SIGNED:__.-_�,'t/'/ <br /> : T <br /> : r <br /> I ; <br /> i <br /> _ �j� <br /> 1H <br /> J .( f I �..} I <br /> : <br /> �-.. <br /> I t <br /> �. <br /> F..� <br /> - ? _ <br /> 1 i <br /> Olw <br /> _ r <br /> L. <br /> I <br /> DEPARTMENT <br /> y�ULEO?g Y7 <br /> • LOCATIDW APPLICATION ACCEPTED BY. ,.b �_l zItEA V'� EMPLOYEE IDY 73 DISTRICT 55 <br /> .____- ............_.__.._.__DATE: <br /> INSPECTED By. ���� '' <br /> ()AT l `-F.:tjpRPERM1'I PINAL ,�YES DATE._. ._INSPECTOR: <br /> C(1MMENTS,-I_.` W <br /> ,fff .::::M1ll......III�......LIL!{L�•(((YC[[ _....__.—___.---------------- <br /> PE CODE. SC rO AMfHINTf.HF.0 .,I, RECEIVED <br /> RXMITTF.O T DATE PERMIT.SERYICE M1EQ1JESl. INL'OICFI SEPTIC ID+ <br /> y <br /> RRVpED sI?-BI ... <br />