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a LIQUID WASTE PERMIT <br /> SAN SOAQUIN COUNTY I'U):3)-IC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 364 F.WEBER AVE 3""FLOOR,S I OCKTON,CA 95202(2U9)468-342n <br /> v`(rN1.-RF.FU7NQA6LE 4N:RMi j EXPIRES FROM DAT?ISSUED PARCEL SIZE:, <br /> JOH ADDRESS f7�1J- JJ Cf�- fYll(/pI�'`�J(�Lf['_� (`f/LI �7 -]//.., <br /> C:1TYlZIP— .y L'�k E/.+fes' ^` eL �`� BI ILDING PERMIT b `� r7C-R <br /> OWNER NAMF_ + __I y`" ADDRESS <br /> CITYIZIP_ __ PHONE NUMBER_ O�]`�q a� <br /> CONTRACTOR 4[+_.b 4_ 4� �ru`=�DDRESS� 'r ' C V z/L <br /> .ff <br /> CI'CYlZIP— `- 1`-'_ PHONE NUNHIFR__. o2 [ ,� f �I <br /> GEOGRAFHTCAL INFORMATION: COORDINATES. X Y TOWNSHIP RANGE SECTION <br /> 'T'Y OF SEPTIC WORK; TN�LLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION KESIDLNCE NUMBER OFBFDROO:VIS: _ <br /> LJ REPAIR/ADT)ITION IZ COMMERCIAL <br /> ZI DESTRUCTION Cl OTHER NUMBER Of EMPLOVF,FS: <br /> ❑ FNGINEF.RED,,ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER; _ WATERTABLE DEPTH, <br /> ❑fPF.RCTEST(S) 1IOW�MANY APPLICATION# <br /> IX SEPTIC TANK TYPE,MFG_ ' V CAPACITY #OF COMPARTMENTS <br /> GREASE TRAP TYPE/MFG _ CAPACITY_ #OFCOMPARTMENTS <br /> ❑_ PKCTX PLANT DISTA..YCE TQNl':dR ST: W>tiLL FOUNDATION,_ PROPERTY LINE � <br /> Cl LIF!'STATION SIZE—.— TYPE OF rcnnr, SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> N OF LINKS:�LENGTH OF LINES: t 1��IT�I r f <br /> LEACH LINE nls'rANC'E TO NEAREST: \VELE I�.�J FOUNDATION PROPERTY LINE <br /> INFLI'FRATOR CHAMBERS: <br /> ❑ FILTER BED wli]I'H LENGTH DEPTH DISTANCE-IONEARE.SPr WILL FOUNDATION PROPERTY LINE 1 <br /> ❑ .MOUNDED WIDTH LENGTH DEPTH_ DISTANCE'rONEAREST: WELL ` FOUNDATION PROP6.RTY LNFi <br /> ❑ sumps WIDTH 1.FNGTH D9PI-H DISTANCETONEAREST: WELI. FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH- DEPTH DISTANCE TO NEARFSr: WF;LL FOUNDATION _ PROPERTY LINE <br /> It j C . <br /> SEEPAGE PITS #_ � DIAMETER DEPTH 2� DISTANCE TO NEApa:'T; WELL FOUNDATION 4 PROPERTY LINE <br /> A <br /> 1 IIEREBV CERTIFY THAT 1 HAVE PRF,PARED'I'HIS APPLICATION AND THE WORK WILL 8E DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI: UM 24 OUR A MANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 / <br /> SIGNED: TITLE: ��L- DATE; <br /> : <br /> A <br /> A <br /> is <br /> r <br /> c . e <br /> t <br /> l <br /> . raIv'� ii <br /> c�1 <br /> . <br /> 7 f�. <br /> I <br /> 7r X1}4' <br /> .� — <br /> 16 <br /> DEPARTMENT' 'F:O 7Y� r <br /> APPLICATION ACCEPTED B}' - ..--DATE:-7� AREA F.MPLOt'EG Ml&�C K04STMCT _LOCATION <br /> INSPECTED BY: _ DATE V� PERMIT FINAL L3 YES DATE', INSPECTOR. _ <br /> COMMENTS. <br /> PL CODE 5C INFO AMOUNT GHECKP%C II RECEIVED DATE PEA M ITISFRVICE REQUES I n INVOICES SEPTIC IDO <br /> REMIT"IED BY <br /> REVISED&I5-0I <br /> J <br />