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n�-DDD 2sc?� LIQUID WASTE PERMIT <br /> 1J SAN JOAQUIN COUNTY PUSLIC�iEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ������ <br /> 304 E.WEBER AVE J FLOOR,STOCKTON.CA 95202(ZD9)468.3420 <br /> -7 NON-REFUNDABLE PERMIT EXPIRES I-Y7EARR FROM DATE ISSUFD <br /> JOB ADDRESS !JC �� 4(/-S7Z V �, APN L 7 3- 18D'--D PARCEL SIZE:- <br /> CITY/ZIP (JI 1r BUILDING PERMIT 0 <br /> OWNERNAME ADDRESS eb <br /> F/l =a�5 z,.I <br /> CITYI7JP .�G/? PHONE NUMBER O <br /> CONTRACTOR /h/ r_ . ADDRESS_Z/�/ y T�C_/��TfJI'V L•r <br /> CITYIZIP ��A�TcG �lT PHONE NUMBER ��� .i <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X Y TOWNSHIP RANGE_-SECTION <br /> TYPE OF SEPTIC WORK: �IN/STALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION R RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY APPLICATION#_ <br /> SEPTIC TANK TYPE/MFGCAPACITY k OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE'MFG CAPACITY #OPCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Jam' <br /> 0.l LEACH LINE p OF LINES: LENGTH OF LINES: oLcrAna ronueecP: -EL FOUNDATION _ PROPERTY LINE/ <br /> '\ INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DMT"CKTO,G LCT: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DLSTANCTTONLUESI: WELLFOUNDATION PROPERTYLINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH SMT-CLTONLARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DM&NC[TO NLARLW: WELL FOUNDATION PROPERTY LINE <br /> Cl SEEPAGE PITS K DIAMETE0. DEPTH WSTANCITONEARLR: WELL FOUNDATION PROPERTY LINE F� <br /> w <br /> 1 HEREBY CERTIFY THAT I HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS \. <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. /V <br /> MINIMUM 24 HOUR 'ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: /.�1 /i �� TITLE: ����5 DATE: — J�CJ <br /> -1. <br /> jr <br /> llJO... Tti <br /> - _ <br /> PU UC ETNA N R ) - - - <br /> _I <br /> Iit <br /> Im <br /> - , <br /> IV I <br /> 71-Al 1 <br /> DEPARTMENT U <br /> APPLICATION ACCEPTED BY: DATE: O AREA�I� EMPLOYEE IDYy DISTRtCft�LOCATION <br /> INSPECTED BY: DATI�or PERMIT FINAL a YES DATE: INSPECTOR: <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT ECK ASH RECEIVED DATE PERMITSERVICEREWFSTI INVOICE4 SEPTI[IDM <br /> REMITTED By <br /> 111 32bi0Gy6 '' ��o z,FlDS <br /> REVISED R4141 <br />