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r <br /> LIQUID WASTE PERMIT <br /> SAN IOAQUIN COUNTY 304 E.WEER AVEa3X°FLOOR,STOCKTON,CA 9202209)"R--342C HEALTH SERVICES ENVIRONMENTAL 0 DIVISION <br /> JOB ADDRESS I V •� O 1.. ./'` 2.00�TBLE PERMIT EXPIRES 1 YEAR FROM �jE SSS^EI� <br /> jf,(`y/ //F'1(\'� O�E (J PARCEL SIZE:' 1 <br /> CITY/ZIP ' 0 r e. �` � {/�` //q �`� ' BUILDING PERMIT# `, �^/ <br /> OWNERNAME C���+ �� � ` 1� ''1 ADDRESS 1,�''-2 �//} 7'� <br /> 1 Inr q�Z 3 I PHONE NUMBER` � L 7 • D <br /> CITVIZIP LL ,w ,(w��/Lf 19,.(_J�( ,r/'��' ��•/" <br /> CONTRACTOR-JA� he nI ,1 '/��`L♦�(Y} �� "� ADDRESS //�//� 1__ ,4 ////�"`,�� YY/ <br /> CITYlZIP �.bf4� RIUI`[D PHONE NUMBER �B/�— ]�D <br /> V TOWNSHIP RANGE SECTION <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X <br /> TYPE OF SEPTIC WORK: <br /> INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 7•: <br /> PIT/SUMP SOIL CHARACTEW, WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY I APPLICATION# <br /> CAPACITY— <br /> GREASE <br /> COMPARTMENTS <br /> ❑ SEPTIC TANK TYPE/MFG <br /> GREwSE TRAP TYPE/MFG _ <br /> CAPACITY #OFCOMPARTMENTS <br /> ❑ - � <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL <br /> FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES:_— OIbTANCCTONeARctt: WELL_ FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> WIDTH LENGTH DEPDISTANCETONEAREAT: WELL FOUNDATION PROPERTY LINE <br /> ❑ <br /> FILTER BED TH ' <br /> ❑ MOUNDED WIDTH LENGTH <br /> DEPTH DISANCETONEAMW! WELL FOUNDATMON PROPERTY LINE <br /> ❑ SUMPS <br /> WIDTH LENGTH DEPTH__ DLWANCE TO NEAREST:, WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH_ DISTANCETONEARLST: WELL_ FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # <br /> DIAMETERDEPTH_ DISTANCETONEAREST: WELL__ FOUNDATION PROPERTYLINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION <br /> NAND REGULATIONS OF SAN AQU N AND THE WORK WILL BE DONE <br /> INDACOUNE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES <br /> 1//qt/71NIMUM 24,HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: r <br /> /� TITLE� v DATE:-9_17�4 <br /> 1 i <br /> _, '7,L -,... <br /> S� N 004 25 30• E <br /> lilt Co -34� <br /> < <br /> 6�-w CwNM LVR LDKL <br /> 27.8 ACRES E Ie <br /> ROO C1�� .P <br /> \ <br /> IR <br /> RECERVE <br /> R �. 7 <br /> O ♦ :mo, SAfa,i"g IIIM ;�(n <br /> — s D�4 30•E-,s�D—�• <br /> 1T P AN _ I <br /> DEPARTMENT USE ONLY a <br /> ,4. 1=)-AREA�I� EMPLOYEE IDM DIS �LOCATIONJ� <br /> APPLICN ACC D � �DACTE � � <br /> i DATE: � / PERMIT F7Ny(CI YES DATE! INSP <br /> INSPE OBY: \ <br /> COMMENT ' <br /> PERMITR RVIC REOUEETM INV01 SEITIC IDM <br /> PE CODE SCINFO REMITTED CHECKM H RECEEY ED DATE l/ <br /> p <br /> 4222 5zl 0 IDDB�- 41o1oz, ' sR001150 <br />