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LIQUID WASTE PERM'" �! <br /> —I �OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEN, / EALTH DIVISION <br /> C 304E.WEBER AVE 3A'FLOOR,STOCKTON,CA 95202(201"8-3420 <br /> JOB ADDRESS a o Lc7�r 200 <br /> 0 -REF,UNQ1BLE PERMIT EXPIRES I0YEAi FROM�A]'E ISS^E� <br /> I�.�,� ` A 'C/1l BUILDINGPERMIT PARCEL SIZE: 1 <br /> CITY/ZIP �, ^�^ IIT J1}'(C\�^ nR s�37 /� / �,. IE2 r^/fir' <br /> OWNERNAME ` /[L�\ 1 l�� Jl�- l��C.�� ADDRESS I a^] Z(/ ( I1��7'�f1(1/1 � ' I r envy <br /> WWI <br /> CITY/ZIP��C}�Q�LY,� D�/.�j��/�/� /a 31y�Y; PHONE NUMBER { - - q7-70 70 �� /� <br /> CONTRACTOR II ` (�� 1_ l�Y` l IY U{T/,/�Yc-"`1//��'�3I, ll` 1 1 ADDRESS 1� Co V� <br /> CITY/ZIP A-�L�� \.� 1. 1 VIl o PHONE NUMBER (/W-/ 3(070 <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> i <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> Z) DESTRUCTION L3OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTM WATER TABLE DEPTH: <br /> )Q-PERC TEST(S) HOW MANY I APPLICATION <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS - <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE / <br /> ❑ LIFTSTATION SIZE TYPE Of PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCETONEARM: WELL FOUNDATION PROPERTY LINE <br /> 4 <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DIWANCETONEAREW: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISI'ANCETONEARECT: WELL FOUNDA40N PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREW: WELL FOUNDATION PROPERTY LINE C <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DEPTANCETONEARECT: WELL FOUNDATION PROPERTY LINE 7 <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEAREAT: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> /ITY�yy�� <br /> NIMIUMI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)46&3423 .` <br /> SIGNED:�,� 001,, AllIh— TITLE DATE: <br /> II <br /> • �� 'V'"�•_ N 00? 2V 30-E 1821.5T <br /> sr <br /> 22 8 ACRES E <br /> moo \ I m <br /> � <br /> PAYMLI <br /> RECENE <br /> O <br /> SAPJJOAt)UP1C^tl, V <br /> Y V PUBLIC,HLl l'c. ",��t;� <br /> / <br /> 'dlPdHrl:-fAA6s1u�;I—�;•-_IG4 <br /> \_ <br /> SITE PLAN <br /> V <br /> 11 _i <br /> DEPARTMENT USEE�1ONLV <br /> A"LICA ACCEP ^D /� DATE- 4 n AREA�/h EMP`yLOyY'EE IDp DIS �LOCATIONI <br /> INSPE DBY: /� DA X �//G�.. PERMITF1N YESDATE! INSP <br /> �6 <br /> COMMENT^ /'• <br /> PE CODE SC INFO AMOUNT CHEC H RECEIVED DATE PERMIT/SERVICEPERMIT/SERVICE REQUESTx INV01 SEPTIC IDx <br /> REMITTED BY <br /> 4222 521 $9 lqhllvz ' SR00 Z950 <br /> Tru,l oma <br /> RRvrscD.-TUI Ij7 O OQ—q <br /> q G <br />