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LIQUID WASTE PERM1 <br /> S)krmbAQUIN COUNTY PU$LIC HEALTH SERVICES ENVIRONMENINMANNEALTH DIVISION <br /> (1 304 E.WEBER AVE 310'FLOOR,STOCKTON,CA 952021209146x-3420 <br /> NON-REFUNDABI.F.PERMIT EXPIRES 1 YEAR FROM DATE ISSUED IoA +tn <br /> JOB ADDRESS �Cti� H -lr��I`'.� 4►',I`-N V APN L 1' G9 In _ PARCEL SIZE: "• yA"'G� <br /> CITYIZIP /� --Lf�fE7. Cit 9f:,-,A 6-1 BUILDING PERMIT N /- �• <br /> OWNER NAME } L,E,F liJ f1�/ ADDRESS 3VA C--):? 7i 4 }W—f-`i n r.J S'�I' <br /> kC L <br /> CITYIZIP 4 'h �� r-L - c A 9��a.lrr PHONE NUMBER U p <br /> "0 ) C-R`{�( I`• <br /> hE�l 1_YI�L."�F�M, Ij° ADDRESS ry O l�1�+1.'j�.w'I�NjCf �S`••�../f�'tL.I�'A <br /> CITY/ZIP Lc- f -.4,q I-, PHONE NUMBER <br /> 7 <br /> GEOGRArnICA 1.INFORM ATION: COORDINATES: X.._ _ Y z TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION LI RESIDENCE NUMBER OF BEDROOMS: <br /> LI REPAIR/ADDITION ❑ COMMERCIAL <br /> El DESTRUCTION L3 OTHER <br /> NUMBER OF EMPLOYEES: <br /> ❑ ENGINEEREDIALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': SA I%1-'I 1^010-; PIT/SUMP SOIL CHARACTER: =>+ Pty( Le.-At.!- WATER TABLE DEPTH odd <br /> Z <br /> PERCTEST(S) HOW MANY 4 APPLICATION# <br /> ❑ SEPTIC TANK TYPEiMFG_ CAPACITY # <br /> Ll GREASE TRAP TYPEIMFG CAPACITY FCOrA IIiNITS <br /> U PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERT E L.4 <br /> ❑ LIFT STATION SIZE TYMOFPUMP SAND OIL SEPARATOR iENCLOSED SYSTEM) 0 <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLiTRATOR CHAMBERS: Q <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCETONEARM: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL _ FOIiNDATION PROPERTY LINE <br /> ❑ Slumps WIDTH LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT T HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTYORDINANCES.STATE LAW'S <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: J �I 1 TITLE: DATE <br /> t <br /> .. 3 i <br /> € <br /> - - - <br /> . EDWARDS ROAD <br /> - - . - — <br /> 'po <br /> .-.....................�.. SITE <br /> i ... .-. .__. _ P�- .. �� .................... . -- <br /> - .1N..1 GROOMS ROAD <br /> .__ ............ <br /> VICINITY MAP <br /> C H c T T a ■ a A l [ ) I.... .- - <br /> I_ <br /> DEPARTMENT USF ONLY <br /> RATE. ��J 3 AREA le EMPLOYEE Ibk DISTRICT LOCATION <br /> '4 <br /> INSPECTED BY: _ DATE: A-f PF.RMiTFINAL❑ YGSDATE: INSPECTOR:_- <br /> rECODE SC INFO AMOUNT CKI ASH RECEIVED DATE PERMITISFRVICE REQUEST- INVOICEM SEPTIC IW <br /> REMITTED BY <br /> SR0033WL <br /> nn•rcrn w.w.n. . <br />