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LIQUID 'ASTE PERMIT <br /> SAN JOAQU'IN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEAL ISION <br /> 304 E.WEBER AVE 3i0i FLOOR,STOCKTON,CA 95202(209)469.342&MP� <br /> `n'! A�j• G'^ '�/'��I ,,,yrrJ[tt�N/O'1yN-REFUNDABLE PERMIT EXI;LR ES I YEAR FROM DATE ISSUED _ 4 <br /> JOB ADDRESS ,//���' 1 y• N..L.f 1 Y( 1al(c I�lsl• APN ©3 1~ !1 O— �8 PARCEL SIZE: IZ - <br /> CITY/ZIP LIrV\ rCA BUILDING PERMIT a <br /> OWNER NAME\J3 ��, "" S ekus ADDRESS <br /> CITY/ZIP 36-rd I^�y��,�IyY'[�,('Vy�V���V 1Jf�'cO�/ PHONE NL'�A1BER\�' \I J1{'1{q , C 1�•J�y+� V•f 1 <br /> CONTRACTOR 0. T-1Yv l Vt-7 JlJl 1� / \C'']L_1 ADDRESS � `y• +1 Il.l1�'��J \lJ/ 1�i 1• <br /> CITY/ZIP WeiU ICA �i 5 4U PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X Y - TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ZI 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 DEPTH: <br /> / <br /> k YERC TEST(S) HOW MANY�_�'APPLICATION# �`` �`� �,.� -S <br /> ❑ SEPTIC TANK TYPE'MFG_ /IJ v�d" �J.�W+91TY #4j�gMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY_ #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: oLSTAnct'ro nEARtvr: wELL iOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> (^ <br /> ❑ FILTER BED WIDTH LENGTH DEPTH D4ttAN'Ct 10 NEARER: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> ❑ SUMPS WIDTH' LENGTH DEPTH DI.RTANCE TO NEARER: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIRANCt TO NBARLT: WELL FOUNDATION PROPERTY LINE _ rn <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DIRANCETONEAREST: WELL FOUNDATION _ PROPERTY LINE <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 JOAQU'IN COUNTY. <br /> MINIMU 24 HOUR ADV NCE NOTICE REQUIREDFORINSPECTIONS-PLEASE CALL(209-)469.3423 QF <br /> SIGNED: I via, ',COJ � S TITLE: . r r/r'Cr -1DATE: <br /> I . . <br /> !R , <br /> 1 <br /> [orf lA..N•TEL,A,. <br /> . <br /> DEPARTMENT US ONLY <br /> APPLICATION ACCEPTEDBYV 61DATE �AREA <br /> 1 EMPLOYEE 1111It DISTRICT LOCATION—23 <br /> INSPECTED BY' DATE: PERMITFINALO YES DATE. INSPECTOR'. <br /> COMMENTS: <br /> PE CODE SCINFO AMOLNT CHECK. ASH RECEIVED DATE PERMITSERVICE REOL'EST. INVOICEa SEPTIC ID, <br /> REMITTED BY <br /> S6�M30 64q <br /> RES'ESEDR.IWI <br />