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zooa-s /mg LI QUID WASTE PERMIT <br /> o <br /> SAN PUBLIC HEALTH SERVICES ENVIRONMENTAL�IVISION <br /> 304 E.WEBER AVE 3p"FLOOR,STOCKTON,CA 95202(209)4NR-3 <br /> NON-REPUNDABLE PERMIT EXPIRES 1 YE/A/�R Fltor) A/MT/E''1 sus. ��p�, <br /> JOBADDRESS /8333 LI�3E2rY SII- APN gll� ' I ll l�� PARCELSIZE:9-1nF�-`-�'S <br /> CITYlZIP /IGH//Ip� t�IN , BUILDING PERMIT n A A <br /> OWNERNAME Q JLT r M 11y I> LL ADDRESS x 0o ,�•nQ-A-� L_I E �D. <br /> CITYIZIP CI"N( ELIL GG._l1�C �IS/bZ4 PHONE NUMBER (SIG) &q0' 43060 <br /> CONTRACTOR AJ,EL A. 4JJD,5-t6oIJ ADDRESSl-E``OJSTo:.I r7 �j 7 <br /> CITY/ZIP LOOT 64 15Z-1 Z PHONE NUMBER Cj2AM/ No?- 3 /01 <br /> GEOGRAPHICAL INFORMATION: COORDINATES: % Y TOWNSHIP-RANGE-SECTION- <br /> TYPE <br /> OWNSHIPRANGESECTIONTYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDI'FION ❑ COMMERCIAL <br /> N LIMRN:R OI+N:M 1'LOYEN:N: <br /> ❑ DESTRUCTION O OTHER <br /> ❑ ENGINEEREn(ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY 4 APPLICATION FA - 02000SS <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTXPLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES:_ DISTANCETONEAREST: WELL FOUNDATION PROPERTY UNE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DECTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREIT: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH_ ORTAWETONEAREAT: WELL_ FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER_ DEPTH DM. ANCETONEARENT: WELL_ FOUNDATION PROPERTY LINE O� <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 HOURADVANCENOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE:_r1EC.D i'�GFI DATE: _ S Z O� TTI. <br /> C . <br /> -I -� T" ' E "X76 , Q- I�(vl9 I (TJT}O �`\ l• J d�- <br /> 4- <br /> C <br /> - <br /> -L <br /> n p - -� - <br /> 131 <br /> _p <br /> 7 EcLgv� _Tj <br /> k .R� )— <br /> o. <br /> IF <br /> {6E MACKVILLEIsazmROAD <br /> ry� AT <br /> eF �= a QLHEt;a tC ------ <br /> I _ I I r <br /> e <br /> _ <br /> I <br /> DEPARTMENT USE ONLY 7 .'/u� W ^ <br /> APPLICATION ACCEPT DATE: AREA/I EMPLOYEE IDp �0/ ' DISTRI(T�LOCATIONY <br /> INSPECTED BY: DATE: s--�' 71 PERMIT FINAL LI YES DATE: INSPECTOR: <br /> I <br /> COMMENTS2 TESTS o Id� �-� aTO ' �C9�3 0•o0E d ¢/ <br /> �v�j m N Aw4D 3o T y mIU y 3�� rJ <br /> m �a <br /> PE CODE SC INFO AMOUNT kSjjg&WASH RECEIVED DATE PERMIT6ERVICEREQVSTT INVOICEA SEPTIC IN <br /> REMITTED BY <br /> •;2-2 JW 356 Al0(03 Loi 6� 0 52�f'�y�Udi <br />