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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICF--� ERONMENTAL HEALTH DIVISION - <br /> rr <br /> n]S J0/E.WEBER AVE 3""FLOOR,STOCV4 95202{209Y 4EN-3410 <br /> NON-REFU ABL R EXPIRES]'YEAR FROM D TE ISSUED <br /> �.2� PARCEL SI LE5 <br /> j JOB ADDRESS _ <br /> CIT•Y17I1 BUILDING PERMIT <br /> OWNER NAME L���/`^� ADDRE5j- 7 <br /> CITVIZIP PHONE NUMBER <br /> ADDRESS <br /> ' CONTRACTORC'`C - X �Z <br /> a 67 <br /> 31��993 <br /> CITYlLIP PHONE NUMBER - <br /> GEOGRAPHICALINFORMATION: COORDINATES: X Y - TOWNSHIP RANGE SECTION <br /> / <br /> TYP. F SEPTIC WORK: INS A9'IONwILLSERVE: NUM BER OF LIVING UNITS: <br /> NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIRIADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> D DESTRUCTION ❑ OTHER <br /> - I -_ ❑ ENGINEEREDfALTERNATIVE 4 <br /> ... . . -Af <br /> 15C <br /> CHARACi'ER OP SOIL TO DEPTH OF 3' /�- ITISUMP 5014 CHARACTER: WATER TABLE DEPTH: <br /> � 3 ❑ PERC TE.YF(S) HOW MANY <br /> /� ,APPLICATION# <br /> 91'SrPTIC TANK TYPEIMFG ('rmc. S�"`�' _ CAPACITY11 4 OF COMPARTMENTS—-jc2- r I <br /> - ClGREASETRAP TYPE+MFG CAPACITY - #OFCOMPARTMF�NTS <br /> K R� '❑ PKGTX PLANT DISTANCE TO NEAREST: WELLLr FOUNDATION PROPERTY LINE �� <br /> [3 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> C <br /> _ .LEACH LINE #OF LINES: LENGTH OF LINES:"' r p[sl'ANCETU NEAREST_ 'WELL) , FOUNDATION�= PROPERTY LINE <br /> 2NFLSTRATOR CHAMBERS: <br /> - Q FI LTER BED WIDTH LENGTH DEPTH DIRTANCE Ta NEAREST: WELL FOUNDATION PROPE0.7Y'LIN <br /> ❑ MOUNDED WIDTH' - LENGTH -DEPTH DI.TANCETONEARIU�EF: WELL FOUNDATION PROPERTY LINE t <br /> Ll SUMPS WIDTH .LENGTH DEPTH p ICTANCE TO NEANERT: WELL FOUNDATION - PROPERTY LINE <br /> ❑ ISPOSAL PONDS WIDTH LENGTH DEPTH pLSTANCE TO NEARM. : WELL FOUNDATION - PROPERTY LINE <br /> I <br /> EEPACE PITS # DIAMETER 4 r1 DEPTHDISTANCETONEARF.ST: WEL DOI FOUNDATION-1—LJ PROPERTY LINEL =_+ <br /> L `1 <br /> I I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE HONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M ]MUM 24 HOUR AD TICS REQUIRED FOR INSPECTIONS-PLEASE CALL(2091)460-3423 <br /> SIG �yINED: TITLE: �`Y" _DATE: r -/Z'O� <br /> -rt- r . 4 <br /> ! <br /> •.�---I �-�� -- -�-----�- � _ "�E �, .� ; �-�._ a-�--!- <br /> I I <br /> 7- <br /> DEPARTMENT VSK OLY �--/'' <br /> APPLICATION ACCEPTE BY: ✓11' bATE:-7hREAEMPLOY EE IDkISTRICF LOChTI N C1`J <br /> - INSPECTEDB DATE: 746 PERMIT FINALI YES DATE:- � _INSPECTO 77 <br /> - COMMENTS: a <br /> T <br /> PE CODE SC INFO AMOUNT CHEC ASH RECEIVED DATE PERMITISERVICE REOUESTM / INVOICEM SF,PTiC IOM <br /> REMITTED BY <br /> j. <br /> REVISEDLI.l1 - - I <br />