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:f <br /> n LIQUID WASTE PERMITn <br /> SAia­AQUIN COUNTY PU)3LIC HEALTH SERVICES ENVIRONMENTAL h- )TH DIVISION <br /> 304 E,WE13ER AVE 3""FLOOR,STOCKTON,CA 95202(209)468-34ZO <br /> Q -7 l'W '1 '} NON-REFUNDABLE,PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> _._ 258 <br /> JOB ADDRESSC+ . HWS qq APN-O, - 109(1 -. 53 PARCELS]ZE: b• �� <br /> CITYlZIP_ 'rl� BUILDING PERMIT# <br /> OWNER NA,MAF1'(�N <br /> .. -{�� g �w&f-`� ADDRESS 1000 JD M ��� <br /> rn) <br /> CIT'YlZIP !'<3p►►AA �V �J�S PHONE NUMBER J!t"'{ <br /> Acz <br /> CONTRACTOR_KLD0Nht-D S1�fl� '.L ADDRESS O <br /> CITYlZIP 15IL40 PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y_ TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> 4 NEW INSTALLATION ® RESIDENCE NUMBER OF BEDROOMS: _ <br /> $ REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTI1: <br /> ❑ PERC TEST(S) HQW MANY APPLICATION# <br /> SEPTIC TANK TYPE/MFG &)Lj5T%:ljCAPACITY_I,ZPO NOF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPEIMFG 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 <br /> SI LEACH LINE #OF LINES:- L4ENGTH OF LINES: (2DISTANCE TO NEAREST: WELL (a0} FOUNDATION_ PROPERTY LINE. Q! <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED - WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> - <br /> U MOUNDED WIDTH LENGTH DEPTH DMTANCET 0 NEAREST: WELL FOUNDATION PROPERTY LINE ,vim' <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE 1 <br /> N❑ DISPOSAL PONDS WIDTH�j �- LENGTH DEPTH o[STANCETONEwkKCT; WELL FOUNDATION PROPERTY LINE <br /> Ad SEEPAGE PITS # ✓ DIAMETER ��r DEPTH �5! DISTANCE TO NEAREST;'- WELLISd+ <br /> FOUNDATION PROPERTY LINE 10 <br /> I <br /> 1 HEREBY CERTIFY THAT I 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. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR[NSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED; _ _ TITLE: C&J,y l C;rt)f- DATE: 0411.51UZ. <br />............. V l 1I I I I { <br /> --.......... ` t <br /> , <br /> i I . <br /> l <br /> ...... .... .. . - .. _ . i <br /> 11 .t ....... <br /> „I..... ..... ... „ <br /> ...... ........ . . r <br /> 1 <br /> I 1 <br /> -, <br /> I <br /> -.-..,.,..............................., -....1....,..,{ �... ..- ..,.. �. �.,..-...I. .Wil_-..,._ , .I 1- l.,.., �.,.,..-.{ ....� ....,_,...-I . <br /> 1 <br /> 3 t I + { I <br /> I .-.,.-. .. ' <br /> ....,.. _-.-.. - ...... -...i...... <br /> �.. I ....' 1 l vi f ` I <br /> .... .. ... ..f....l �.. _ �..._ _ I rCCE11' FI i } <br /> I � { <br /> : <br /> k...... .......�._ t <br /> I <br /> 47 <br /> ._.. I € i i <br /> au Jr <br /> O = i <br /> DEPARTMENT USE ONLY <br /> APPLICATn0y <br /> BY' DATE;: 1 I AREA [� EMPLOYE O A/ _ I _ A ru <br /> D,TRIC _LOCATION�_(. <br /> INSPECTSFk DATT���� PERMIT FINAL} YES DATE: INSPECTO fff <br /> COMMENTS: bof S n `i I''tfi 1 �- <br /> PE CODE SC INFO AMOUNT CHECK#! SH RECEIVED DATE PERMITISERVICE REQUEST# INVOICE# SEPTIC[D# <br /> REMITTED BY ' <br /> s�00114-55' <br /> I <br />