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• LIQUID WASTE PERMIT lQAt X'30 <br /> 5 SAN JOAQUIN COUNTY PUJILIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 30.'FLOOR,STOCKTON,CA 95202(209)46H-3420 <br /> R'EEFUNCDARLE PER EXPIRES II YEAR FROM DATE ISSU D om' "jDg <br /> JOB ADDRESS l°J— APN /Vt h O PARCELSIZE:A <br /> CITY/ZIP7�//�)��'-'SIV/— BUILDING PERMIT p <br /> OWNER NAME Y 6 `K 7 ADDRESS <br /> CITY/ZIP A/AI n��j PHONE NUMBER <br /> x <br /> CONTRACTOR �V �D I` f`-o L �^` <br /> CITY/ZIP PHONE NUMBER S7 Ste <br /> `e <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> LI NEW INSTALLATION -e�ESIDENCE NUMBER OF BEDROOMS: <br /> �REPAIR/ADDITION ( ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <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 /> ❑ GREASETRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTXPLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) _ ,�•'I: <br /> >)Q LEACH LINE #OF LINES: LENGTH OF LINES: DL—NCE TOnuRECF: WELL(DIDOr FOUNDATION J� PROPERTY LINE <br /> /` INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DLtiTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH -WANCE TO NEARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DLWANCETONEARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DINTANCE TO NEARL�: WELL FOUNDATION PROPERTY LINE <br /> SEEPAGEPITS #_ DIAMETER,5-V DEPTHWELLWI RwT <br /> FOUNDATION,za PROPERTY LINE <br /> I HEREBY CERTIFY 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. <br /> INIMUM 24 HOUR VAN ICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 g <br /> SIGNED:' TITLE: DATE: �o <br /> I ) <br /> 1 <br /> �. <br /> - — - .._... <br /> _ �. <br /> Q r7C '.r <br /> I <br /> DEPARTMENT t)SFJONI,Y <br /> APPLICATIONACCE EDB Y: _DATE:_IZfl EA#EMyPlLLO/YEE I11). N <br /> p �RI LOCATIO <br /> INSPECTED Y: DAVE''���6' PERMIT FINALq YES DATE' <br /> COMMENTS:J <br /> PE CODE SC INFO AMOUNT IQ!ECKp/ H RECEIVED DATE PERMIT/SERVICE REOUESTO INVOICE# SEPTIC IDp <br /> REMITTED BY <br /> 40+is 3(4loL , �lZgQ3 <br /> REVISED M-1 S-0I <br />