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::ATION FOR LIQUID WASTE PERMIT <br /> SAN QUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENYiRQNMENTAL HEALTH DIVISION <br /> R0.BOJ(388, 446 K SAN JOAQUIN ST.,STOCKTON,CA 36201-0388 <br /> j ROO)488.3420 <br /> NDN-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUE <br /> Application is hereby {Campleb in irip7kateJ <br /> is made in c made to the Sen Joaquin Count for a <br /> services, EnvripralrraentalrHealth couritK <br /> Y permit to construct and/or int Title, Chapter 9111 / install the work descri <br /> Job Address or and the Stand fid• This application <br /> / APH# 3� - !/ � �r d of San Joaquin County public Health <br /> E= -1: 9 5� <br /> '.. owner's Name � > _ City <br /> - f��f Address .Lot size 15 <br /> CDntractOr - cf <br /> s: AddresZSub contra c � <br /> tor <br /> Lit I�8 <br /> TYPE OF SEPTIC MIRK: Address ��Phone 7-/1/77 <br /> (NO SEPTIC SYSTEM PERMITTED IFkPUBLICTSEWER IS AVAILABLE WITHIN 200 FEET OF BUILD[ !ic# "'~~IL <br /> REPAIRIADDITiON[] Phone <br /> DESTRUCTION pEAC TEST <br /> Installation will serve: NG-) Ili Naw man <br /> Naber of I lvfn Residents]- Coatnercial LaM Da Appikatipa D��/ /� -30 <br /> IJ uniror �` Other 6?� <br /> Character o} coli to ^� N,+aber of bedroamor '� `ypjp ) 1 <br /> • depth of 3 feet. Nunber of employeaa: ��_._-�. / mel <br /> SEPTIC TANMIDREASE Pit/S ' <br /> TRAP 1) TYPa/Mfg tuP Soil character: <br /> PKO TREATMENT PLANT ^"CaP��. Water Table Depth <br /> [ 1 Distance to nearest: acfty <br /> 4efl ----�No, Compartrnente _ <br />{i <br /> Foundation <br /> STATIOl LIFT Size P Type of P — Property line <br /> LEACHING tliE <br /> C) Na, & length of lines SerK1 Oit Separator (enclosed system) <br /> FILTER BED Distance to[7 Nearest;Width Length Well FoundationMOUNDED Depth aProperty Lin <br /> (] Width Length Well on <br /> SEEPAGE PITS Depth Property Line t- <br /> [I Depth -Size Nuber Wei( Foundation <br /> SDAIPS fl Width „ " Wel[ Property Line -- <br /> Length Dept Foundation Pro <br /> DISPOSAL PONDS i] Width P " W*"_ party Line <br /> Length Depth Foundation Pro <br /> � party Line <br /> 7 hereby certify that 1 have reWell Foundation <br /> p pared this epp[icatian and that the work will be done in accordance with son Jb ProPerLy Line <br /> and State Laws, and Rules and Regulations of the San Joaquin County, Hagx owner or licensed agent's signature certifies the fano <br /> I certify that in the performance of the work for which this <br /> to becere subject to he per�Jtm �s c ��^County oil roan 6s <br /> foliowin8: 'V certify that in the ampensation laws ok California.,,rmContractores ] shall not er to an ng , <br /> compensation taws of California 14�rfarmance of the York for which this hfrrn ars y y e rsl in such a mama <br /> S ub-cantractin sill nature certif'es he <br /> The aPPiissnt <br /> must call 24 hours in advaoca tot a0 regslrM i Permit is.issued, I she[l employ persons subject to if +s <br /> mpecliatm, COM drawing below. <br /> Signed X <br /> �.�• 1 Tit[e� <br /> 1• <br /> Names *t~� �y� Dair• <br /> 2. out I i =o�i /�ci6� l <br /> 3• Dimer- 4• location of house sewage disposal system <br /> andStrw�! 7' a,J"- - S. <br /> Proposed expansion of is disposal wC A PARQptIQ 2 Location of wells within radiuspof 150yft <br /> $o to I < the property or adJafn,'n9 property, on <br /> _ P pe y. <br /> E <br /> 5 �il�lUR i iw x <br /> a Na �.,� I PARCEL 3 <br /> a <br /> —{ I—R.wiL.fwJ L Tui <br /> Y E <br /> T <br /> I V ID <br /> PARCEL 1/ I---ar <br /> o�:at d o,�r,.� � <br /> O,f j, N,.- ol AU3 19 4 <br /> f I. 5A 'JO Q01 <br /> W0 <br /> �ci JNl1 <br /> a� I PARCEL 4 EN IAC MEN AC EALT i0VSION <br /> 0:,a. <br /> G, Ac. NOi <br /> P <br /> IIl/.Ir' <br /> R qp <br /> l Oilli A D <br /> PP ration Accepted -`- -- -- <br /> 'ank, Pit or Sump Inspection by �+ Date: ;J Area; <br /> Date F <br /> �L teal In <br /> dditionel CDm+nehts: spection by <br /> ��� �. 7 ate <br /> d & <br /> ACCOUNTING ONLY: AID# <br /> FAC# 2 �2fr�e� <br /> PE CODE FEE INFO AAlOUNi REMITTED CNECNACAS � <br /> M RECEIVED BY DATE BR i PERMIT NUMBER INVOICE <br />