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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)669-3420 <br /> I.r <br /> NON-REFUN ABLE PERMIT EXPIRES I Y'F./A.,R FROM D�gJTE ISSUED <br /> JOB ADDRESS_ `r /U 1 " -I,-P U� ('� APN V I Q `Q PARCEL T SIZE:-4 <br /> CITY/ZIP ,\ ` `� ,II C � el-5 �j 'l BUILDING PERMIT N 10 `IV Y/ <br /> OWNER NAME +0.w�Cit L'` 1 1 1 C1�\2 -2- ADDRESS I T% n�'. <br /> CITYlZIP \ r CA /� (c" l�J PHONE NUMBER 200 <br /> CONTRACTOR l JCli y' `p\V/ ADDRESS <br /> CFTY/ZIP PHONE NUMBER <br /> ✓r GEOGRAPHICAL INFORMATION: COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> A NEW INSTALLATION J4 RESIDENCE NUMBER OF BEDROOMS: . <br /> O REPAIR/ADDITION ❑ COMMERCIAL <br /> Cl 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 P A/V d l-. CAPACITY -Z4900 g Q 4L. #OF COMPARTMENTS 2 � <br /> ❑ GREASE TRAP TYPE/MFG 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) C <br /> LEACH LINE #OF LINES: LENGTH OF LINES: /100 DISTANCETONEARE5T: WELL"( FOUNDATION ✓` 1 PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DICTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> �` ❑ SUMPS WIDTH LENGTH DEPTH DICTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <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 t <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ,_ 11NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> N� SIGNED. VV TITLE: DATE: <br /> - <br /> i <br /> _ I <br /> _ r <br /> A JUG W <br /> unS F.I4 ES <br /> i41— <br /> i <br /> PVr <br /> �� 0///\TIL' ,` DF.PARTMEEN/TUSEONLY <br /> APPLICATION ACCEPTED BY: (.A0 al&tVV DATE: r-13-2- AREAEMPLOYEE IDa DISTRICfLOCATION* <br /> ar INSPECTED BY:��Il J <br /> y� DATE: D�� PERMIT FINAL 12 YES DATE: <br /> COMMENTS: <br /> w~ <br /> PE GOOF SC INFO AMOUNT CHECK ASH RECEIVED DATE PERMIT/SERVICE REQUEST# ItNVOICEa SEPTICIDA <br /> REMITTED Ry <br /> 4 Z 1 i -3 ZQ /D424 �a3 0 it Q Q 3 06� <br /> REVISED S-1541 <br />