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p LIQUID WASTE PERMIT <br /> ef <br /> SANIOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 300 E.WEBER AVE 3-FLOOR,STOCKTON•CA 95202{20%4641-3420 <br /> NON-REFUNDABt,E PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS A�IOO ej �C RSSOi.J Q� APN oj-D - o,-' S_A <br /> PARCEL SIZE: C <br /> CT'PZJP lzo%o O 59-1 BUILDING PERMIT <br /> OWNERNAME . " ^T QO 40-1)21 ri <br /> C1 ADDRESS 'AGO W^t—e10- �e:eJ�r(4, +'Z.A AN^�b� <br /> CtTY17AP �7 1 OGC.-TCN CR 61�h 00, PHONE NUMBER b 6 1 <br /> CONTRACTOR OIJS�GyL <br /> ADDRESS -__ <br /> CITYPLIP _... PHONE NUMBER <br /> GEOGRAPHICALINFORMATION:OOORDINATES:x <br /> `....- t' TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE <br /> TO REPAIR/ADDITIONW COMMERCIAL NUMBER OF BEDROOMS: <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: _ <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PTT/SUMP SOIL CHARACTER: <br /> WATER TABLE DEPTH: <br /> ❑ PERc TEST IS) I4OW MANY APPLICATION# <br /> 13 SEPTIC TAIiK TYPEIMFG CAPACITY <br /> p OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEfMFG CAPACITY #OF COMPARTMENTS W <br /> ClPKCTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY Q <br /> LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUA/P SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE �OF LINES: -L LENGTH OF LINES: Q b oISTANce TONEARE67. WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FR,TER BED WIDTH LENGTH DEPTH OISTANCt TONIAALCT: WELL <br /> FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DL9fu:C1 TO NEAREIT: WELL <br /> FOUNDATION PROPERTY LINE C <br /> ❑ SUMPS WIDTH LENCTH DEM- DMTANCITONEAR[AT. WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCITONIARI,c1: WELL FOUNDATION PROPERTY LINE A <br /> ❑ SEEPAGE PITS DIAMETER DEPTH DLCTANCITONEARE41•: WELL V <br /> FOUNDATION PROPERTY LINE �( <br /> I HEREBY CERTTFY THAT I HAVE PREPARED THIS APPLICATION.AND THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES,STATE LAWS `{ <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MIN1114 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE: 'T'lta -^et DATE:�"' N-O'er <br /> I -•�----f--'—'- -1----i-1--t7�1---' -- , <br /> I __..1-_.._,__ C--,�-•I i_ __ �+ ...-� I -� i � _ 7-T <br /> t - <br /> J 1_ - o � -G- <br /> cT <br /> j - <br /> ..r �..____•--r-i--I—�-----— 1- ! �_ I I <br /> -Ir i-;- TI +� 7 <br /> _ _ <br /> I <br /> 1 I <br /> _ iA <br /> I <br /> DEPARTMENT USE ONI.V I/,, Q7^' <br /> APPLICATION ACCEPTED BY: (�l'�}1 '�AAEA,�11 v EMPLOYEE/IOD�3fl Y DISTRICT_LOCATION <br /> INSPEENTS: : \_.- DATE: V J� PERMfT FINALS YES DATE:SS Z+t "( <br /> .iLlySPECTOR� <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT HE <br /> REM•PTED H BYE DATE PERMITrAERVICE REQUM40 INVOICEF $EPftC IW <br /> ZEO els j p 0 .00 3 0 S <br /> REVI5ED.11-I'HI <br />