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141w) <br /> LIQUID WASTE PERMIT <br /> SAN JO.AQL))N COLN'1 Y PUBLIC HEALTH SER4'ICE:S ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.W'F.DFR AVE 3k°FLOOR,STOCKTON,CA 95202(209)468-3420 <br /> O RFFLlNDABLE PERMIT EXPIRES I YEAR FROM DATE <br /> ISSUED <br /> V <br /> JOB ADDRESS APN 0 ! V F C4 PARCEL SIZE: -A <br /> C1TVIZIP +'r' B[:I[.DINC;PERMIT# a (- C.J <br /> Jf C <br /> OWNER NAME Q�� o1 G Q�.tn,—s, nDDRF.SS v,2 <- w J <br /> CITYIZIP s4-f14+��?'I 1 PHONE. NUMBFRf_ - �� j <br /> r ,ff <br /> CONTRACTOR �� Q"L Q17 ADDRESS / 2 [.� <br /> CIT'YlZIP o L� _- PHONE NUMBER _[ / �/ /- <br /> GEOGRAPHICAL INFORMATION: COORDINATES: x Y TOWNSHIP RANGC' SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: I <br /> NEW INSTALLATION '( RF.SIDFNCE NUMBER OF BEDROOMS: <br /> ❑ RFPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: CJj <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED,,ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY �( ! APPLICAT[ON; <br /> SEPTIC TANK TYPE,MFG_ `�- A. C���Y•;4 r— CAPACITY 14 O 0 0OF COMPARTMENTS �- <br /> ❑ GREASE TRAP TYPE-MFG CAPACITY _ 0 OF COM PARTM ENTS 1" <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOL!NDATIDN __ PROPERTY LINE <br /> ❑ LIFT'STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #CIF LINES:_-I LENGTH OF LINES:�-!�./! DISTANCETO.NEARE5T: W'F.I.L� FOUNDATION o PROPERTY LINES L <br /> INFLITRATOR CHAMBFI�: r:7 <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEP"IH DISTANCE TO NEAREST: WELL_ FOUNDATION PROPERTY LINE <br /> lzi <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEAREW: WELL_ FOUNDATION PROPERTY LINE In <br /> dA f/ f <br /> ❑ SEEPAGE PITS # DIAMETERWsa_ DEPTH y DISTANCE 70 NEAREST: V'ELL� FOUNDATION 100-f PROPERTY LINE <br /> HEREBY CERTIFY THAT 1 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. <br /> M[NIMWA 24 HOU ADVA E NO ICE REQUIRED FOR INSPECTION'S—PLEASE C kLL(20 468-3423 <br /> SIGNED: � .� —TITLE: ►1 DATE: <br /> .....__ ...,. <br /> 1 - <br /> I�Q <br /> . i <br /> ....73 <br /> ......... _ <br /> F <br /> �r <br /> _I Nr4!�Flew L 5 <br /> I ..... <br /> 5 . - .. <br /> 10 <br /> .._,.., . <br /> 5 I�1 ClFaiaUl[li�7L1NTY' <br /> PUpl IC HEATH SERVIC S <br /> F. <br /> N�RL,N <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPT'- BY: DATE: Z I1 MPLOYEEIDN D LOCATION_jq- F <br /> INSPECTED BY _ _ DATE:AC)/'54Z PERMIT FINAL YESDA7E r�� /«INSPECTOR ) <br /> COMMENTS.. <br /> PE CODE SC INFO AMOUNT HECKM ASII RECEIVED DATE PERMITISERVICE REQUESTx INVOICE# SEPTICIIJI <br /> REMITTED BY <br /> 310 ��- �0313 � <br /> REVISED%-IWI <br />