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UID WASTE PER T <br /> LIQUID 24 I\J®—F CE <br /> y„K SAN JOAQUL:COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL IiFALrH DIVISION <br /> 3(Y)E.WEBER AVE.,3"O FLOOR,STOCKTON.CA 95202 (209)463-3420 F ��w�*P 4- —F' E] <br /> VT_3V Ak <br /> /� NON-Itl�;l%UNUABI,1?1'IiRM1II-f I?XI'lltlsS 1 1'1?AR PltOpl UA'1'1%ISSUED 0 N S� GTI C7 S <br /> JOB ADURBSS��� p,�lj�r 'i � 61 4<4z rye p p di4 L?57Z D <br /> CITY/ZIP 4ca" i00 C-,4, PARCELSIZF/AAPN 2 7 4,g-, A-f7Aj . D07-D CSO -7 <br /> OWNER NAME M 4►"C Garn to- 7 ADDRESS /I 7a h Doc Dkl <br /> CITY/ZIP L D di to �{�G � PHONE t �p <br /> CONTRACTOR r`✓ZC�i�� �`yJZj ADDRESS -5 3-55 .SOIQr cdK <br /> CITY/ZIP 5 -,-qn PHONE F-31— / 3 7 <br /> n� <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X��,,,,y�Y TOWNSHIP `SECTION <br /> PERC TEST(S) ( ) HOW MANY �� f -"`"�`� A�ION#: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION " ��✓� <br /> INSTALLATION WILL SERVE: SIDENCE ($> ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> 1_ <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE LA/W'S,AND R LES AND R 'ULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: Cf T� c TITLE: V%/tL- h, DATE:�b�dD <br /> Y •sr w m w ocn�v <br /> I <br /> DesI6tH�RlTWICCR PAW-a-I <br /> Ievw Ileo <br /> I "m <br /> ' I <br /> PA%C&9 <br /> � <br /> FIAPZ&Z <br /> e Ac. <br /> t aw ereo <br /> I PA04L 4 <br /> f • <br /> j.Y <br /> PU U, lit=NLTHSz .v. FS <br /> //,��' �I h FO /)EPART 1 N 7 SE ONLY ,/f <br /> API'LICATIONACCEI''1EDBl': V� �- 1 l��✓ -�"' n X/t`YJ- UA'I E:✓ `�"' `~`-1 t-'. <br /> TANK.PIT,OR SUMP INSPECTG�Y:_ fir, r ( /"i �7-` 7,IyATE:_ <br /> FINAL INSPE ION Y: / Cr <br /> C_zleld / <br /> COMMENTS: <br /> Ace <br /> PE CODE I SC AMO NT IEC RECEIVED BY DATE PERMIT/SE EQUEST p SEPTIC 1DR <br /> INFO REMITTED SH <br /> 9 Z p C <br /> caY <br />