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LIQUID WASTE PERMIT Q S�-"O P <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 952(12(209)46M"342D <br /> /J SRT NON-REFUNDABLE.PERMIT EXPIRES 1 YEAR FROM DATE ISSUED !/ <br /> JOBADDRESS ll �. D APN C1 `L� L C-' -' y <br /> PARCEL Sl2:E;•� <br /> CITWZIP -Y BUILDING PERMIT/ n n� n • `�"- Q���� { <br /> OWNER NAME <br /> y�, <br /> CITYIZIP PHONE NUMBER�J <br /> CONTRACTOR ADDRESS .7911 5� <br /> CI7YfLEP !J JIGa4-r 2 y� <br /> PHONE NUMD —L <br /> GEOGRACH[CAL INFORMATION:COORDINATES:%__y TOWNSHIP RANGE SECfJON <br /> iTYPEOF SEPTIC WORK: INSTALLATION WILL SERVE: NUMB <br /> i NEW INSTALLATION &!RESIDENCE ER OF LIVING UNITS: <br /> ❑ REPAIFUADD)TIONO COMMERCIAL NUMBEIZOFBEDROOMS: ' <br /> ❑ DESTRUCTION O OTHER NUMBEROFEMPLOYEES: <br /> C) ENGINEEREDIALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OP 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(SI HOW MANY APPLICATION# <br /> ,01'�EPTICTANK TYPIJvMFG CAPACITY Zjo_nn #OFCOMPARTMENTS <br /> ❑ CREASE TRAP TYPEIMFG CAPACITY M OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST; WELL FOUNDATION PROPERTY LINE <br /> ❑ LIPFSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINE ItOF WNES: el LENGTH OFL[NES:ggE40Z naTANCLTONwILSP: WELLIl�e� FOUNDATRmI�Q� PROPERTY LINE-TO <br /> ]NFLITRATOR CHAMBERS: <br /> ❑ FILTER RED WIDTH LENGTH DEPTH DLSTARCETOKMiImW: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREAT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH{ LENGTH DEPTH DMANCETONPHRM: WELL FOUNDATION PROPERTY LINE y` <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEARLCT: WELL POUNDATION PRUPERTY LINE O <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DD.TANCETONSA M: WELL FOUNDATION PROPERTY LINEcr <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DOME IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS (]T <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> NIMUM24.HO AD A;NCEVTECEREQUIREDFORINSPECTIONS-PLEASE CALL 009)169--3423 <br /> SIGNF,D; !Zellem <br /> Q r, <br /> _ TITL -f4f n_DATIKP. <br /> � <br /> :. _ <br /> i <br /> �. 4._.._..,_-.t---�--i--�_._ ---'�I --I E- — -- -"-I-- '- _ 1 tel. <br /> R <br /> 01 <br /> i SAN!:)AI Ult I CC UNl_ <br /> _.-, VIG <br /> I <br /> -1 { .. - <br /> _ y _ <br /> DEPARTMIEE6LY <br /> R: <br /> APPLICATN ACCEPTTD B - nA7E PG/6 <br /> AREA�EMPLOYEE fDP��pISTttICf�LpCATI � <br /> INSPE[TED DY. DATE 0� PERMIT FINALTS YES DATE: 4—II" ON—'-- <br /> / <br /> IN5PECFOR: <br /> COMMENTS' <br /> PE CODE SCINFO AM.VNT ECK�+C 'II RECEIVE. .ATC <br /> R F.MFTTEo .Y PERMITMERINYOtCFA SEPTIC I.iY <br /> Y71-1 t <br /> f1EV15Cu IFIs01 ' <br />