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F <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 4 304 h-WEBER AVE 3Y"FLOOR,STOCKTON.CA 4520-(209)469-3420 <br /> ' , <br /> NON-REFUNDABLE PFRmrr Expisms i YEAR FROM DATE ISSUE <br /> JOB ADDRESS <br /> PARCEL SIZE: <br /> F <br /> crrvyzlp BUILDING PER/MITA <br /> OWNER NANI E JO ADDRESS 7"1 <br /> c,Tvmp A 0,4,LJ40,sy PHONE NUMBER <br /> F CONTRACTORA////- 11)1).rSI Al /-X ,-e)lj <br /> CITVfZIp 41—0 4:2 PHONE NUMBER___` 07� -5'�7-- ��-70 <br /> m <br /> GEOGRAPHICAL INFO RMATION:COORDINATES:X —Y— —TOWNSHIP—RANGE SECTION <br /> TYE OF SEPTIC WORK: INSTALLATION WILL SERVE; NUMBER OF LIVING UNITS!_ <br /> �4NFW INSTALLATION El RESIDENCE NUMKROF BEDROOMS: <br /> U REPAIR/ADDITION D COMMERCIAL <br /> OTHER <br /> Cl DESTRUCTION LI NUAI13EIZOP FMPLOYEES;. <br /> Q ENGTNHERED!ALTFRNATl%'E <br /> CHARACTER OF SOIL TO DEPTH OF 3';' PIT)SUM P SOIL CHARACTER: WATER TABLE DEPTH: <br /> PFRCTES74SI HOW MANY APPLICATION <br /> SEPTIC TANK TYPE/MFG CAPACITY #0FC0M?ARTMFNTS_ <br /> CREASETRAP TYPE/MFG CAPACITY 90FCOMPARTMENTS. <br /> Ll PKGTXPLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE— TYPEWPOVIP SAN D OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LI LEACH LINE' 0 OF LINES- LENGTH OF L.11%ES: DMANCETONE-EST: WELL FOUNDATION— PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> 13 FILTER BED W107H— LENGTH DEPTH DIFTANCILTONE-M: WELT. FOUNDATION PROPERTY LINE <br /> WIDTH— LENGTH_ DEPTH vKTANCEroMEAREST: WELL FOUNDATION_ PROPERTY LINE <br /> F <br /> Tj sumps WIDTH_ LE-4c;TH— DEPTH DISTANCETO—REST; WELL FOUNDATION PROPERTY'LLNE <br /> r, <br /> U DISPOSAL PONDS WIDTH LENGTH DEPTH .ES: WELL FOUNDATION PROPERTY L114P <br /> SEEPAGE PITS . # 'DtAmETER DEPTH— DISTANCE TO HEARS T: WELL FOUNDATION— PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAY'E 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 /> m2 OUR ADVXN E-NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20)46$-3423 <br /> SIGNE TlTLF- —DATE: <br /> L <br /> -J� <br /> T <br /> 7 -T ... .... <br /> L <br /> -41 <br /> PAYM E I, <br /> RECralVm- <br /> T-7 <br /> 17 <br /> SAN J0AQJlNU1.- <br /> PUBLIC HEALTH SE <br /> III 1"w-LILLLLLuf <br /> 7-- <br /> DEPARTMENT USE ONLY <br /> ." <br /> APPLICATION ACICEPTEDBY: <br /> DATE-�,'r X/ <br /> AREA PW <br /> 1 EMYEEIDO 2VRICf LOCATION <br /> NSPECT <br /> INSPECTED BY: DATE'.- PERMIT FINAL ,)ATL >, — <br /> CCM MIENTS: <br /> PE "1 11 INFO AWIUNT CNECKItDASH <br /> REWT�El) \'REV <br /> F DATE PERM17INERVICE REOUESTO kEPTICrN <br />