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L1QU1D "WASTE PEP" <br /> IT <br /> SAN JOAQUIN COUNTY PUS LIC HEALTH SERVICES£NVIROn lTAL HEALTH DIVISION' <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)466-3420 <br /> � l <br /> NEON-REFUN�AB E P RMIT EXPIRES 1 YEAR FROM DATE ISSUED q <br /> JOB AE�DRESs�/a, ✓` '(/ 1 Y� 1 ppN O Z I„r �-(� t 1 PARCEL SIZE <br /> CITY/ZIP V Qf C��� BUILDING PERMIT# y' <br /> OWNER NAME I�"-I SQ�S ADDRESS cZ9-4S 2- A <br /> CITYIZIP all <br /> /� *� PHONE NUMBER <br /> CONTRACTOR -�dak-M Cj 1 [S _ �Z�� © '� 5' r2 <br /> ADDRESS -W/ _ � � <br /> { CITYIZIP ` <br /> ' PHONE NUMBER VVV <br /> GEOGRAPHICAL INFORMATION. COORDINATES: x Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> q NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ElREPAIR/ADDITION ❑ COMMERCIAL <br /> LI DESTRUCTION L) OTHER NUMBER OF EMPLOYEES: <br /> Q ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERCTEST(S) HOW MANY APPLICATION# <br /> ❑ 'SEPTIC TANK TYPE/MFG <br /> CAPACITY #OF COMPARTMENTS <br /> i <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY #OF COMPARTMENTS <br /> - ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE - <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND:OILSEPARATOR(ENCLOSED SYSTEM) . <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCETON'EAREST: WELL FOUNDATION PROPERTY LINE o <br /> INFLITRATOR CHAMBERS: }I` <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST; . WELL FOUNDATION PROPERTY LINE <br /> D MOUNDED - WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEARE.ST: WELL FOUNDATFON. PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH - DEPTH WSTANCETONEAREST: WELL - FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH D[sTAivcETONewxESr: .. WELL -FOUNDATION - PROPERTY LINE <br /> 5 <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN.C'OUNTY ORDINANCES_,STATE LAWS t <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> j M[N 24H U DVANCE. REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 f <br /> SIGNED: TITLE:_ <br /> L DATE: c <br /> , <br /> J <br /> ow / <br /> sem(✓ <br /> I ,..,. <br /> ih <br /> d.� <br /> ._.. <br /> L /�p� p 3 <br /> // <br /> .\yf <br /> ' rr✓. PARD 4. ' / r JOF 5 <br /> me F . ' a fy �,FrssAti <br /> r <br /> � � 3 <br /> Ia�'i r <br /> a <br /> Y Y .-.—... — — _ <br /> x+--.-.�.,+R..rr. � <br /> i <br /> DFPARTMENT SE QNLY <br /> APPLICATION ACCEPTED�y DATE: AREA�EMPLOYEE IDilill ST LOCATIO� <br /> INSPECTED BY'. )ATE.ATE; PERMIT FINAll S DATE: y NSP OR: <br /> �OMMF.NTS4 <br /> l.J�\ <br /> U <br /> t <br /> PE CODE SC INFO AMOUNT CHECKNIC H RECEIVED DATE PERMIT/SERVICE REQUESTIA INVOICEN '- <br /> REWTTED BY SEPTIC[j�4-� <br /> REVFSED fl-15-01 / J -� •� �lwb7r�lrG � <br /> .GI.� �. <br /> -c�..,., , ..r,✓ !�r/� �,�. .:.� .�r,�,.�.,.! :�:.�J aril.'�i�� <br />