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n��DDo 2Sc� LIQUID WASTE PERMIT <br /> 1J SAN JOAQUIN 10 COUNTY P AVE 3"FLOOR. <br /> H SERVICES ENVIRONMENTAL HEALTH DIVISION ^�ID <br /> l0a E WEBER AVE) 'FLOOR.STOCKTON.CA 95202(209)46%-3420 1._ O <br /> /� <br /> NON-REFUNDABLE`PERMIT EXPIRES I l'F.AR FROM DATE ISSUED <br /> JOB ADDRFSS 3(, _./ j Z'/ e/o APN Z y3- I80^D <br /> y T PARCELSIZE: <br /> CITY/ZIP BUILDING PERMITR /lam <br /> OWNER NAME /CG,Q /S�-� ADD0.ESS QC U� /�iT/ le <br /> CITY/ZIP ���� G�// PHONE NUMBER /,� 7 <br /> CONTRACTOR /�/ �l✓L (/ � ADDRESS_Z/S/ �O 1�ri�d I/��j/ GJI'V Er <br /> CITY/ZIP PHONE NUMBER�7 <br /> GEOGRAPHICAL INFORMATION: COORDINATIS:% Y TOWNSHIP. __ _RANG[ SECTION <br /> TYPE.OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> � <br /> NEW INSTALLATION R RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR./ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERF:DALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: PIl'/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PFRC TEST(S) HOW MANY // APPLICATION a <br /> SEPTICTANK TYPE/MFG ( L-/ CAPACITY MOFCOMPARTMENTS-J-2 — <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY MOFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPE OF rUMP SAND OIL.SEPARATOR I ENCLOSED SYSTEM) <br /> LINES: GT t r T P <br /> �L LEACH LINE aOF LENGTH OF LIN ES: u1cTAnc[To n[..nc T: WELL FOUNDATION PROPERTY LJNE� <br /> /\ INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DI.TANCf.TONEARL4T: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH o "CETON[ARLR: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LEN(TrH DEPTH .-A—TON[ARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS d DIAMETER DEPTH om-cl TONEARLi WELL FOUNDATION PROPERTY LINE rJ <br /> W <br /> I 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. /V <br /> /A"MINIMUM 24 HOUR ANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)468-3423 U <br /> SIGNED: /,l�Al /i —,­- TITLE:� DATE: <br /> i I i I I <br /> n 14 <br /> PU LIC EA H FIV IiT4Sr \ SL <br /> I <br /> _ V I <br /> DEPARTMENT UC <br /> APPLICATION ACCEPTED BY: DATE: SO ARFA_�f EMPLOYEE IDP DISfRICT I LDCATION-9-71 <br /> INSPECTED BY: DATE/ D a/ PERMIT FINALR YE9 DATE: INSPECTOR. <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT 4 K ASH RECEIVED DATE PERMRSERVICE REWFSTr INVOKER SEPTIC m[' <br /> REMITTED By <br /> 1 ? 320ro Gyb '' o 2-F106- <br /> REVISED R•IS-11 <br />