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A�' - LIQUID WASTE PERMIT -�� a-- <br /> 11N' SAt.�QU1N COUNTY PUJJLIC HEALTH SERVICES ENVIRONMENTAI�ALTH DIVISION <br /> JOR E.WEBER AVE J""FLOOR,STOCKTON,CA 952021209)4fiR-JR20 <br /> �!7 7�7- I� NON�RJE,[•,1/J�IDABLE PF-RMIT E%PIRF.Sp1 YEAR FROM DATE ISSUED F-L <br /> C)C� (�'. (F• �j PARCEL SIZE: <br /> CITY/ZIP `�2"�1[ Cy BUILDING PERMIT# C `C' �-7 C\ / <br /> OWNERNAM L�%1�`I T'1 C+ �1�2LL/�- J ADDRESS es'A�"'`"'� <br /> CITY/ZIP PHONE NUMBER ���'j ({�:,. <br /> CONTRACTOR VYv ADDRESS - �{JXCJ�" /l �`�� <br /> CITY/ZIP S✓/ �� PHONE NUMBER '7,?/7-7 C o <br /> GEOGRAPHICAL INFORMATION: COORDINATE'S: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: \INSTTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION 'RESIDENCE NUMBER OF BEDROOMS: <br /> O REPAIR/ADDITION /❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION CIOTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITBUMP SOIL CHARACTER:CII( -TT— WATERTABLEDEPTIi Cn f <br /> ❑ PERCTEST(S) <br /> HOW MANY !� APPLICATION# - <br /> SEFTICTANK TYPE/MFCC11ArC- ` VIS CAPACITY lzoo #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGT%PLANT DISTANCE TO NEAREST: WELL �� , FOUNDATION G ' t PROPERTY LINE 1 -{ J, <br /> ❑ LIFTSI'ATION SIZE TYPEOFPUMP SAND OIL SEPARATOR IENCLOSED SYSTEM) <br /> ` ^ II <br /> LEACH LINE #OF LINES: 3 LENGTH OF LINES: DERANCE TO NIARett: WELL/an FOUNDATION I� /'L" PROPERTY LINE 7 V <br /> LI TO HAMBERS: - I <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DIWANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ DPWNCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DLRI'ANCETONEAMW: WELL FOUNDATION PROPERTY LINE <br /> S:) <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEARLV : WELL FOUNDATION PROPERTY LINE_r <br /> LJ/ SEEPAGE PITS # �:ol DIAMETER—� DEPT)Y- ( DISTANCE tO NEAREST: WEL� S J FOUNDATION( a •(- PROPERTY LINE CT•T <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK W EJR9NE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> ANO RULESAN TIONS OF SAN JOAQUIN COUNTY. <br /> NIMU 21 HOU A AN NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)469-3433 <br /> SIGNED: TITLE: DATE: <br /> .... _. ...T ._.... -' ..... <br /> O B 7 ... _. <br /> 1 .- _ _ I <br /> I <br /> $� <br /> 01 <br /> _- <br /> -- I ' ,4-4 <br /> -- 1 <br /> _ .. a j� <br /> t <br /> I � <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY: /-DATE:—AREA—EMPLOYEE y IDR DISTRICT }-�LOOCCATION <br /> INSPECTED BY� 1 11DATE:/O+,2 OMIT FINAW YES DATE:[/-COMMENTS: <br /> PE <br /> PE CODE WINFO AMOUNT C NICASH RECEIVED DATE PERMITISERVICE REOUESTN INVOICEN $EMIL IDN <br /> REMITTED BY <br /> gZII C (' .l� � i . <br /> gEVRB:D41RJ1 <br />