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LIQUID WASTE PERP"`T <br /> G JOAQUIN COUNTY PUBLICHEALTH SERVICES ENVIRON A♦/LHEALTHDIVISION <br /> e..�� 704 E.WEBER AVE 7 'FLOOR,STOCKTON,CA 952021,. )OM1R-7420 F-I 4-✓Q <br /> T NON-REFUNDABLE.PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ISSUEED �p/�/`+ <br /> JOB ADDRESS -1 17,10 APN 7- `O^ `/ PARCEL SI'/.F.:!O I <br /> CITY/ZIP 7 l BUILDING PERMIT � / � / <br /> O\VNER NAMELL�J4��'(�1��A7��LNJJl/}' iA 1 fi IL- hl 4/.r ADDRESS /`•✓/ZS S7 ku s L/% Twi irr (J'77 <br /> CITYIZIP r7S 3'Z['7 PHONE NUMBER <br /> CONTRACTORI�.L-fNn1 GFt-`LD�1Lc• AooRFss ��z'S�\&^ Y/LT+L�-/ <br /> SCITY/ZIP r—V'/�I1 z�JJ_ PHONE NUMBER ("et) <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X V TOWNSHIP RANGE SECTION - <br /> TVPE 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 /> '- ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY T, APPLICATION# <br /> ,❑` SEPTICTANK TYPE/MFG CAPACITY It OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES:_ DIsrANCETONURM; WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH UIRFANCETONFARPAT: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ DIRFANCE TO NEARER: WELL FOUNDATION PROPERTY LINE <br /> ❑ $UMP$ WIDTN LENGTH DEPTH_ 1IM. ANCETONEAREW: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIAMNCETONEAREAT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH_ DIRANCETONEARERT: WELL FOUNDATION PROPERTY LINE < <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK W ILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 24 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PL,EJE�A��SE� CALL(209)468-3423 <br /> SIGNED: TITLE: Y /L rjj-S =DATE: <br /> ��/d� r <br /> z --- -- - <br /> g <br /> R � I ___ <br /> � <br /> }}_ _ z <br /> 1 <br /> g111111LLLil r <br /> I <br /> r <br /> STAIE HIGHWAY 120 voite <br /> FIELD OF DREAMS K KJELDSEN U44 bEu+.d ,"„�;'„"„ ma �� N - <br /> _ 4 _ i <br /> ' -- -----�-- R' 31157 HWY 120 ESCALON CA 95320 S SINNOCK 10X"^'«' <br /> I ! u oononern N NFllflL'CK +w•�M��row m: RF [n <br />