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4jaW LIQUID WASTE PERM�� <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3R"FLOOR,STOCKTON,CA 95202(209)468-3420 <br /> ON-R BLE PERMIT EXPIRES 1 YEAR FROM ATE 1 SSUED �Xj/ L <br /> JOB ADDRESS ?7(o7 <br /> /� A) }r—/I + APN ^V 3 V <br /> � r/� ({,��► PARCEL SIZE:_ <br /> CITY/ZIP lel BUILDING PERMIT N <br /> OWNER NAME--T M ` �.(ij/LC t�yy ADDRESS�_KY✓�-+�- <br /> CITY/ZIP A PHONE NUMBER <br /> CONTRACTOR �./ "�G - ADDRESS —�-Y —7 I <br /> CITY/ZIP PHONE NUMBER IL 1 (Y <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y_ TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ <br /> ❑ NEW INSTALLATION IDENCE NUMBER OF BEDROOMS: <br /> W11EPAIR/ADDITION ��OCOMMERCIAL <br /> (�❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG f CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r / r OF <br /> 111 #OF LINES: 1 LENGTH OF LINES: ` st1f •f- '—/l aa <br /> EACH LINE DISTANCE TO WELLSy FOUNDATION PROPERTY LINE <br /> I TRA'OR CHAMBER :�� <br /> ❑ FILTER BED WIDTH LENGTH( DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED" WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ <SUMPS WIDTH- DEPTH DI.STANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ,,,--❑ DD��- I_SPOSAL PONDS WIDTH LENGTH 2! DEPTH DI.STANCETONEAREST: WELL COFOUNDATION PROPERTY LINE f <br /> �� S)EPAGE PITS # _ DIAMETER JW r' DEPTH / DISTANCE TO NEAREST: WELL I O' FOUNDATION PROPERTY LINE 3 <br /> (]I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. OC <br /> MI MU HOADVANC <br /> TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 /�7 l <br /> SIGNED: TITLE: DATE:/ c -13-0/ <br /> 1 <br /> ioor <br /> + E <br /> , <br /> : <br /> —�— <br /> .. -I -- <br /> _..... <br /> ......... <br /> _._...... _.�. -- 4-_ _ _.�_...-_. <br /> . R.. <br /> 30 t <br /> (N <br /> t i <br /> i <br /> : <br /> -- .. <br /> �. f <br /> ---t-- N F ...... I <br /> .T, <br /> I <br />