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` LIQUID WASTE PERW— <br /> S wo6AQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEN,%BIIEALTH DIVISION <br /> 304 E.WEBER AVE Y"FLOOR,STOCKTON,CA 95202(209)4".3420 <br /> RR. <br /> 9 �1���NOONN.REEF�fDDABLE PERMIT EXPIRES I YET FRO7M�D/ATE ISSU�EID x <br /> JOB ADDRESS_ 19000©OD G,/"// %/�'c/ APN O f�I J TYJ - O�+ PARCEL SIZE:_m <br /> n I - p <br /> CITY/ZIP �-C/F�YV/Kw- BUILDING PERMIT <br /> OWNERNAME Jam • " - � ADDRESS <br /> CITY/ZIP PHONE NUMBER ^7�V�� <br /> CONTRACTOR \ _ ADDRESS�u // �PIOy/��j�'(j�"' `� L� � <br /> ` CITY/ZIP PHONE NUMBER 64 -/ / .J o <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X V TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTA ON WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: <br /> REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: G <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE L <br /> •. CHARACTER OF SOIL TO DEPTH OF 3':At <br /> PIT/SUMP SOIL CHARACTER:? �4)/.SWATER TABLE DEPTH: (C <br /> ❑ PERC TESTS) HOW MANY APPLICATION# v <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY #OFCOMPARTMENTS 44 <br /> O GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS 3 <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE -Z1 <br /> r. ❑ LIFTSTATION SIZE TYPE OF PUMP_ SAND 01L SEPARATOR(EPIC LOSED SYSTEM) C <br /> R <br /> LEACH LINE #OF LINES: LENGTH OF LINES:--It 0 DLRANCe TDNEARe.4F: WELL[ FOUNDATION PROPERTY LINE 06 <br /> ` INFLITRATOR CHAMBERS: �_ r <br /> C <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DLRANCETON"Ra4F: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ DIRTANCETONeARM: WELL FOUNDATION PROPERTY LINE a <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DfCFArvce To rvEARRSF: WELL FOUNDATION PROPERTY LINE <br /> Z) <br /> \❑ DISPOSAL PONDS WIDTH LENGTH DEPTH_ DIRFANCETONKARLST: WELL FOUNDATION PROPERTY LINE /� <br /> 1R/ SEEPAGEPITS'�'„ #� DIAMETERy'� DEPTH� I DINTANCf TONEAaecF: WELI�P FOUNDATION_ PROPERTY LINEI Qt/ / <br /> LI 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 /> IMUM HOUR A CEN E REQUIRED FOR INSPECTIONS-PLEASE CALL(209)46&3423 <br /> SIGNED: I - �I�I 'EZZ'� TITLE: DATE: <br /> _.r ��A £ <br /> r . <br /> t <br /> A, <br /> ogYEN <br /> -- T RFCEIVEP — <br /> +- X w5< LtUiJ 3 2003 _ <br /> (7 SFNCQA011ICI4 VI <br /> PU C 4W SE VIC 6 -.- <br /> 6VI AIJA NTnt rT4 Q f,' sI©N <br />