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LIQUID WASTE PERMJT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEi 'ACTH DIVISION <br /> 704 E.WEBER AVE 7"D FLOOR,STOCKTON.CA 932021 7420 <br /> NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> f <br /> JOB ADDRESS /' //�C/AIG ?Q APN 25 PARCELSIZE:�� <br /> CRY/ZIP iQ4 c- !2S377 BUILDING PERMIT <br /> OWNER NAME B!F. 5 e/O//r-• ADDRESS 10 3 <br /> CITY/ZIP SACPAQ: kS Ai 004 PHONE NUMBER (--20q) 3"H2 <br /> CONTRACTOR_ _ Al"ErL A . A/J D � ASSOLADDRESS as 1•fa J S 6/LJ L AJ <br /> CITY/ZIP_ PHONE NUMBER ar'1) 3C 7'376 1 <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X Y TOWNSHIP-RANGE-SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> Cl ENGINEERED/ALTERNATIVE - <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> XPERCTEST(S) HOW MANY „[ APPLICATION <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY III OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gOFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION' PROPERTY LINE <br /> ❑ LIPC STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINE B OF LINES: LENGTH OF LINES: DKTANCETONEAROT: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH 0M. ANCETONEAREFT: WELL FOUNDATION PROPERTY LINE .� <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DKTANCETONEARLW: WELL - FOUNDATION PROPERTY LINE ,O <br /> ❑ SUMPS WIDTH LENGTH DEPTH DLXTANCETONEARUT: WELL FOUNDATION PROPERTY LINE O <br /> I ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEARL57; WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS k DIAMETER DEPTH DISTANCE TO NEARER: WELL FOUNDATION PROPERTY LINE (� <br /> j I HEREBY CERTIFY THAT LHAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS C <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMUM 24 HOUR ADV AN E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)4684423 <br /> it <br /> SIGNED:-- TITLE: n TAT Jj. DATE: <br /> b <br /> I ►f <br /> - _ <br /> - Au 0, <br /> o• <br /> IVI <br /> /F T <br /> I <br /> i <br /> `.� '---_"-- •- --... _..-..-"-- - _.. �. .-------'--�-.-_.-...._.....-...ul Hllt 1l t;.�n <br /> L b - <br /> ` I I �- <br /> DEPARTMEM'USE ONI. <br /> APPLICATION ACCEI•TED BY: �✓ AT,E -AREA✓/6 EMPLOYEE IDM:;�• DISTRICT LOCATION <br /> E�.�3 f <br /> INSPECTED BY: DATE: PERMIT FINALES DATE •U/ INSPECTOR: <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT CHECK CASH RECEIVED DATE PERMITISERVICE REQUESTO INVOICCR SEPTIC IDE <br /> EMITTED BY n <br /> X2.2 z S zI 179 4lDlo3J L6 %2/DZ S/' �yG�i^� ,-R 1 <br /> REVISED x.1101 <br />