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' LIQUID WASTE PERMIT <br /> +�J SAN JA!KIN IN COUNTY PUBLIC HEALTH SERVICES ENVI NMENTALI����H DIVISION <br /> 304E.WEBER AVE 38"FLOOR,STOCKTON.CA 5202(209)4)%A <br /> I <br /> NON-RX ^RDATE <br /> ISLC F. <br /> JOB ADDRESS O 37 C 9 APNDLO - 2- 1 PARCEL SIZE: <br /> p <br /> CITY/ZIP -��Y L� ^ BUILDINGPF.RMITS 490 <br /> / C L <br /> OWNER NAME V� QTS e-S ADDRESS <br /> CITYZP PHONE NUMBER <br /> CONTRACTOR_y /V/`-� ''�`� �- ADDRESS &.y///`' <br /> CITYIZIP PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: ��`INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> . :fN1EW INSTALLATION �l(ESIDENCE NUMBER OF BEDROOMS: 1�. <br />/`❑ REPAIR/ADDITION / El COMMERCIAL y-' <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINFERED/ALTERNATIVE l..) <br /> CHARACTER OII SOIL TO DEPTH OF 3' PIT/SUMP SOIL CHARACTER: WATERTABLEDEPTH: /Q0 <br /> ❑ PERC TESTIS) HOW MANY/ APPLI ATION# <br /> SEPTIC TANK TYPEWFG[ IYYY4-Z 7E�Z CAPACITY 14F'O0 #OFCOMPARTMENTS d <br /> / O <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY NOF'COMPARTMENTS <br /> r <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELD'{' FOUNDATIONPROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OILS ARATOR(ENCLOSED SYSTEM) <br /> �A 1 i oD" <br /> dI`� LEACH LINE #OF LINES: LENGTH OF LINES: plsleNCE TO NEAREST: EL FOUNDATION�n PROPERTY LINE / <br /> 1!_ INF MBERS: f _ <br /> ❑ FILTER BED WIDTH LENGTH DEFTH DI.WANCETONEARLW: I ELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DEWANCETONEAREST: ELL FOUNDATION PROPERTYLINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DIIANCETONEAREW: ELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIRTANCETOXEARENF: ELL FOUNDATION PROPERTY LINE <br /> SEEPAGE PITS # DIAMETER_qv NP L DEPTH D18ANCE TO nEAgESI': ELL FOUNDATION La PROPERTY LINE ZD <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCOR ANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN UNTY. <br /> MINIMU <br /> 4H R ADVANCE NOTICE REQUIRED FOR INSPECTI S-PLEASE CALL(209)"S-3423 <br /> SIGNED: TI LE: DATE: I .2' 1 O-O Z <br /> ; �" <br /> I <br /> I-�— <br /> I�.._ ,..... <br /> 0 - <br /> - t , <br /> F c InIP 1e 7 �z„ 4- <br /> , I P <br /> i I <br /> DEPARTMENT USE 1ONLY <br /> APPLICATION ACCEPTED BY: DATE:IZ�II` V �• ARLA �I EMPLOYEE ID# 404DI RI LOCATION L� <br /> INSPECTEDBY: / DATE PERMIT <br /> /FINae-L/Jy YES�DIA.T�� 3 INSPECFO <br /> COMMENTS: <br /> PE CODE SC FO AMOUN CHECKS .ASN RECEIVED DATE PEa M1f IlakllVR'E REQUESTa INVOICEx SEPTIC IDN <br /> REMITTED BY <br /> 4--L i c7 3-10 "t 7Z— S,/— 3213 � <br /> .:II LISA l <br />