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LIQUID WASTE PERMjP--) L7 <br /> SA.,_ .AQUIN COUNTY PU.BLIC HEALTH SERVICES ENVIRONMENT,. .,EALTH DIVISIO <br /> 304 E.WEBER AVE 3k"FLOOR,STOCKTON,CA 95202(209j,168-3420 <br /> I ] <br /> n� '/p / NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED lam/! <br /> JOB ADDRESS dg 1Z.4 <br /> API QO r 70 ^ G,3 PARCEL SIZE: " <br /> CITYIZIP cl m 9507aO BUILDING PERMIT# 0 3 V7 44 0 �� <br /> OWNER NAME ADDRESS <br /> CITY/ZIP pV PHONE NUMBER a� <br /> CONTRACTOR��j�IlrQ� YQ//� r ADDRESS Lq rye , <br /> CITY/ZIP 6o " 9.5,Ala PHONE NUMBER gqq - 5001' <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y_ TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> RI NEW INSTALLATION Cd .RESIDENCE NUMBER L3REPAIR/ADDITION ❑ COMMERCIAL <br /> U DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3% PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ ?ERC TEST(S) HOW MANY APPLICATION# <br /> EPTIC TANK TYPE/MFG� PACITY 6900 GgNQhs #OF COMPARTMENTS,:._, ' <br /> ❑ GREASE TRAP TYPEIMFG <br /> t CAPACITY <br /> 7 #OF COMPARTMENTS <br /> �y—/❑ PKCTX PLANT'. DISTANClTO NEAREST: L {N+� FOUNDATION L✓ PRGPERTY LINEr <br /> //� <br /> ❑ LIFT STATION SIZE TYPEOE PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I �y <br /> F LENGTH: OLINES: 75 DISTANCETONEAREST;' WELL FOUNDATION ROPERTY LINE' <br /> LEACH LINE #OF LINES � ' <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCETONEARE.ST: WELL�6 FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE nl , <br /> ❑ SUMPS WIDTH LENGTH DEPTH DfSTANCETONEAREST; WELL FOUNDATION PROPERTY LINE <br /> G�r}pQ I <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEAREAT: WELL FOUNDATION PROPERTY LINEri <br /> ✓ Iol <br /> SEEPAGE PITS #__, 49 _ DIAMETER Zj _ DEPTH-195— DISTANCE TONEAR8S1'; WELL170 FOUNbATIO .PROPERTY LINE <br /> I HEREBY CERTIFY THAT I 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(249)468-3423 <br /> SIGNED: <br /> TITLE: DATE•1.�7=//�`Of <br /> .-.--._�._.-_, ' s I I f .. .. ! _ <br /> w { I a "f i i--- ].......... <br /> 77 <br /> ...,...... 1...-.,.. .............. ..--.-.. _ E <br /> I.. I I .- T .... <br /> ..--...f...,. .... .. __ <br /> I I I I I I I I <br /> _... 1 <br /> I € _._.�_ I I lad ...... .;.__ ; € <br /> ! 1, r <br /> 3 F I_- e I .- € I �. .�._- I, ....,..,,.-.,_... ,... i .-.-I.,..-- ...-,..,il ..;.... € 1 -1. _ <br /> € -.', <br /> p 1 <br /> f E „I I I ...,.f.,. ._. I 4 <br /> I � J � <br /> _.,..,... -..:--_- p. _�. 1)n I i I ! <br /> ...3 - ..�,.., G - 1 ................ <br /> _ - <br /> I. J ......_ r fi -.-.. F-- 1 _ 1 <br /> 1 <br /> I �4. .,.. I �..,.-..,.., i LVIPN ALTFA- <br /> f I 1 J F f <br /> _- <br /> ...i............. ............ <br /> i .. <br /> I ! I >' <br /> DEPARTMENT US ONLY <br /> APPLICATION ACCEPTED BY: DATE: � <br /> AREAEMPLOYEE ID# �oy4 ODISTRICT�LOCATION <br /> "' <br /> INSPECTEp6Y: DATE: i LPERMITFINAIlQ�YF.SDAf .INSPECTOR: <br /> COMMENTS: ✓✓ / /�� <br /> PE CODE SC INFO AMOUNT CHECK ASN RECEIVED DATE PERMMISERVICE REQUEST# <br /> REMITTED INVOICE# SEPT➢CID# <br /> Ny <br /> 2 3t6 <br /> 6VISEDA-I."I <br /> 1 <br />