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f LIQUID WASTE PERMIT <br /> (.�Rv%CES ENVIRONMENTAL <br /> k SAN IOAQU 04OW£TERUBLIAlE]"' ALTH STOCKTON,CA 95 07 2091469-3 20H DIVISION <br /> �Y NON-REFUNDABLE PERMIT EXPIRES�FAR FROM DATE IS UED PARCEL SfZF: • G�C <br /> wPN <br /> I <br /> 30BADDRESS ✓h <br /> /} O Im'.1NC PERMIT PCrrvlzIr + <br /> h f ADDRESS <br /> � <br /> OYYNER NAME !, 'I 43 <br /> 5 PHONE NUMBER <br /> CITYIZIP ADDRESS <br /> CONTRACTOR <br /> PHONE NUMSEA <br /> 'N <br /> ClTY17.1P TONSISIP RANGE SECTION <br /> Y_ <br /> CEOGRAPIilCALINFORMAT[ON: gooRDINATes-,K NUMREROFLIVINGUNITS: <br /> INSTALLATION WILL SERVE: NUMHEROF BEDROOMS: <br /> TYPE OF SEPTIC WORK: ❑ RESIDENCE <br /> CI NEW INSTALLATION p COMMERCIAL. NUMBEROFEMPLOYEFS: <br /> U REPAiRlADDITION ❑ OTHER_- <br /> p OFSTRUCTION <br /> C1 ENGINEEREDIALTERNAT{-F WATERTABLEDF-PTH: - <br /> CHARACTER OF SOIL TO DEPTH OF <br /> PITISUMP SOIL CHARACTER: <br /> HOW MANY____._- APPLICATION. <br /> Ll pERCTEsr(sI CAPACI.C,l� MOF COMPARTMENTS <br /> p SFPTICTAPJK TYPE(MFG CAPAf.]TV� <br /> #OFCOMPARTMENTS <br /> * GREASE TRAP TYPFIMFG FOUNDATION PROPERTY LINE <br /> r ❑ P%G-r%PLANT DISTANCETONEAREST: WELL. <br /> 1 SAND 011.SEPARATOR[ENCLOSED SYSTEM] <br /> TYPsor PUUP� <br /> ❑ LIYTSTATION SI2E <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: v'�"CETONEAFD : WELL <br /> iOUNPATIDN PROPER."LINE <br /> INFLITRATOR CHAMBERS: PROPERTY LINE <br /> WIDTH LENGTH DEP18 <br /> D15rANCE TO NEA0.CR: WELL FOUNDATION <br /> L] FILTER RED FDVNDATION PROPERTY LINE <br /> ❑ MOUNDED W0TH <br /> [-ENGTiI DEPTH viRAnCB TO NEARLSf: WELL <br /> LENGTH DEPTH DPITANCLT0 NTA0.EtiT: WEL-L FOLNDATION PROPERTY LINE <br /> p SUMPS WIDTH <br /> LENCCt, DEPTH DISTANCE TV NEARGRT: WELL <br /> FOUN➢ATION PROPERTY LINE <br /> [] DISPOSAL PONDS WSDTH 4 <br /> DIAMETER DEPTH DISYANCCTONE41DNT: WELL <br /> FOUNDATION PROPERTY LINE <br /> ❑ SEP.PAGE PITS � - <br /> HE WORK WILL BE DONE IN ACCORDANCE <br /> WITH SAN JDAQUIN COUNTY ORpiNANCE5,STATE LAWS <br /> I HERESY CERTIFY THAT I HAYE PREPARED THIS APPLI ANTI RULGS AND REGULATIONS OF SAN JOAQUIN COUNTY1 <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2 09)468-3423 <br /> TITLE: DATE: <br /> /(SIGNED: <br /> _ <br /> 1 - I <br /> I � 1 <br /> 1I7}E 1 r T <br /> _ 1 <br /> J�/�/J,/�'// DEPARTMENT U F: NLY +]�'y <br /> APPLICATION ACCEPTED BY: ` r'r DATE: D l AREAUL L EMPLOYEE.IDMpOISTRI(-f40CATION <br /> INSPECEDBY: _ DATE: PERMIT FINAL YESDATE: INSPECTQR: <br /> Ln.�mENrs, S2r.�c� V I� T�IQKnJ.wc u <br /> PE CODE SC INFO AMOUNT CHECKACASH RECEIVED DATE rF.RMR4ERV,CEREOOEET. INVOICE. SEPTICID. <br /> REMITTED <br /> S <br /> REVISED 41541 <br />