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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3N'FLOOR,STOCKTON,CA 95202(2D9)469-3420 <br /> NO -REFUNDABI,F.PERMIT EXPIRES I IF <br /> IR01�1 j]�T�ISSL P !_ <br /> JOB ADDRESS PN I `J I`I fy} PARCEL SIZE: <br /> CITYIZIV BUILDING PERMIT t/l'� ��[ [� <br /> OWNER NAME{ 1 � � ADDRESS_I !/ !1 <br /> CITY7ZIP PHONE NUMBER 5 L1? - /C)-7 <br /> AmoCONTRACTURE - 2 0 ! , +,IJP ` ADDRESS,-TU <br /> C1TYIZ.IP ♦�.� ,. PHONE NUMBER- I66 I W <br /> GEOGRAPHICAL INFORMATION: COORDINATES- X Y TOWNSHIP—RANGE—SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION X RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES! <br /> DESTRUCTION.�. C3 OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> Imo-' <br /> CHARACTER OF SOIL TO DEPTH OF 3'. PITlSUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION <br /> ❑ SEPTIC TANK TYPE%MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST' WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE YYPE OF PUMP SAND OIL SEPAFAATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: 101srANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE [\ <br /> INFL[TRATOR CHAMBERS: Vy <br /> ❑ FILTER BED WIDTH LENGTH DEPTH D0%TANCET0NEARXRF: WELL FOUNDATION PROPERTY LINE 1 <br /> ❑ MOUNDED WIDTH LENGTII DFPTH Dl.WANCETONEAREST- WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DIsrANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LPN(jTH DEPTH DrSTANC!_TONEAREST! WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS #-- DIAMETER DEPTH DiWANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFYTIIAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> .AND RULES AND REGO LAT IONS OF SAN JOAQUIN COUNTY. <br /> �241-1�UA�DVANCE NOTICE REQUIRED FOR INSPECTIONSCAL (209)AGB-3423 l <br /> SIGNF,D, T[TL DAT • .02. <br /> EDE `��a� VIII <br /> : <br /> I <br /> t <br /> _. - <br /> , <br /> i <br /> I <br /> e. ._ .5.. <br /> a <br /> �4 <br /> _ _ ___ <br /> ._. _ �_. ...,.. _ ... _._ ...... .... .... ---- - _ I - -- <br /> ., PAY M E <br /> , <br /> . <br /> . 4 <br /> fN COUNTY <br /> Ile <br /> ����•��` tu1NTt_-.IH1=.__ f�_1ll:yl.liu <br /> IUB <br /> rf�Vl�f k� <br /> DEPARTMENT UfSIl++``E ONLY ^J yr <br /> APPLICATION ACC PTEA BY: ' <br /> 'I - DqT£:�' I V y AREA �"� EMPLOYEE IDI J 3 _L_ oTRICT,, LOCATION <br /> INSPECTS BY: - - DATE: -f.>'PERMIT FINAL'J'YES DATE.r— INSPE [SR: <br /> COMMENTS' <br /> �'_ l f :� -�':-L � / 21�r r,r l / .•/_' _ `.L_�If�+r cif <br /> PE CODE SC INFO AMOUNT -HF,F. 'ASH RECEIVED DATE PERMITISERVICE REQUESTO INVDICEA SEPTIC IN' <br /> REMSTfED BY ` <br /> REV ISEO 9-I.W I <br />