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I <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PLBLIC HEALTH SERVIOPSENVIROKMEN'TA I.HFALTII DIVISION <br /> If 104E WEBER AV[Tp'FLOOR.SIOCKTON•CA 9520212091001-3420 <br /> VON-REFUNDABLE PERMIT EX PIKES T YEAR <br /> �FROM <br /> (DATE ISSUED <br /> JOB ADDRESS ( �_JA L�f13(T ) -� APN 41.7–/ d O PARCEL SIZE; 7-4j,� <br /> A� <br /> CITYIZIPBUILDING PERMIT#— / _ <br /> OWNER NAME .,- • :: ADDRESS_„ ` {.U�Tu � I?Agl�x <br /> Clh'/ZIP PHONE NUMBER <br /> CONTRACTOR ADDRESS 4 /� <br /> CITYIZI► _, � !�O __..__., PHONE NUMBER <br /> G£OGRAPHICALINFORMATTI-O�-N_:COORDINATES X Y TOWNSHIP RANGESECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNI TS:—� <br /> ❑ NEW INSTALLATION A RESIDENCE NUMBER OF BEDROOMS: 1� <br /> RF.PAI DDITION U COMMERCIAL <br /> 13 DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ F.NGMEF-REDIALTL•RNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': !••�4"PIT/SUMPSOILCHARACTER: —WATER TABLE DEPTH: <br /> ❑ PF.RCTFRT(S) HOWMANY APPLICATION# <br /> TYP&MFC <br /> ❑ GREASETRAP TYPUMFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTx PLANT DISTAI4CETONEARM: WELL FOUNDATION_ __ PROPERTY LINE <br /> U LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR I ENCL.OSVIJ SYSTEM) v <br /> /4n W <br /> LEACH LINE M OF LINES;_j,LENGTH OF LINF1!:_4&, pMr.ICA TO N[AREAT: WELL FOUNDATION PROPERTY LINE %'j <br /> INFIJTRATURCHAMHF:KS: --,J� <br /> ❑ FILTER BED W'IDTB LENGTH UFPIN 1497AWMTONTAR[ST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH/ DEPTH DLtTANf.[7ON[AR[ST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SLMPS WIDTH LENGTH DEPTH am..C[TC NiwRE'[T: WF.IJ. FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH `_ DEPTiI paaANCR Tonw[sr: W'Eu FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS R DIAMETER DEPTII oRT Nf[mvEAR[rT: WEI.1 FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COCNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGVLA'rKINS OF SAN JOAQUIN COUNTY. <br /> �111RADVANCE NOTICE REQUIRED FOR INSPEC•FIONS—PLEASE LL(208)468-7423 <br /> R �p <br /> SIGNED: �—_ _TITI,F.: D E: V J L <br /> T 7— <br /> T <br /> J. <br /> i <br /> L I .............. i <br /> i. <br /> 1 <br /> I .. <br /> . i <br /> 1 <br /> i <br /> t <br /> p , <br /> Tj <br /> ,_'...r..., <br /> LAN. A IJ1r��TYE6.._F--+-•...._,y.... , �r" y- - i .�—•---t--•t--.y....�. <br /> • HII � 1. ..}. <br /> — Pf18t 1 S 4, <br /> a..EN1fpNfl97KLti6AJk➢t�5'4I�k...___ .)) .... .__ - <br /> I � <br /> _ DEPARTMENTPLEO I.Y '�210/f1 <br /> API('Af10NA(CEPT'2DBY. _DATE: J2 AREA aEMPLOYEE IDI 73�—OISTRIC-F LOC'A'l1AN� <br /> INSFEcTEo BY: - .._.._._._.DATE 1 U� rLRMITFINALY/ti IA1F.: INSPECTO.-!gw <br /> FE CODE H'I O AMOUNT CHVC'Ra ARN RECEIVED DATE rF.RMIT•SERYKE[EpUESTF IN VOIff.. SEPTIC roti <br /> REMITTED EY <br /> yZ I l$o 5,e nv 3 vs y3 <br /> r.•6r� D41S1I _1 <br />