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LIQUID WASTE PERMIT <br /> �\t SAN JOAQUIN COUNTY PUI LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 1 77 Z'q7 306 E.W ESER AVE 3-FLOOR,STOCKTON,CA 95202(209)4/R-3420 �• <br /> I YEAR <br /> ATE <br /> JOB ADDR¢SS�/. I ,.�LCj"�iya N REBI.E PERMIT E%PIRESO,FROM DSS PARCEL SIZE: <br /> APN �^z I(✓ <br /> CITYIZIP__` BUILDING PERMITA, <br /> OWNER NAME f7 PGS,_ �+vv-� J ADDRESS J�••�� <br /> CITYIZIP .- PHONE NUMBER-_ <br /> Dom -7 t cocQ� -- <br /> 'r <br /> COV'I'RA('TUR� ADDRESS - <br /> CHYILIP PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X Y _ TOWNSHIP- RANGE SECTION <br /> POF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS; <br /> CW INSTALLATION (3 RESIDENCE NUMBER OF BEDROOMS:. <br /> EPAHUADDITION ❑ COMMERCIAL <br /> NVMBEROF EMPLOYEES: <br /> _. O DESTRUCTION �CSTHER AOZSL�pq�k <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3'• ITISUMP SOIL CHARACTER: WATER TABLE DF.PTH:�f <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> ..ASE TRAP TYPEIMFG � CAPACITY t2�O #OFCOMPARTMENTS- <br /> Q <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELI�'f FOUNDATMN&k� PROPERTY LINE /Od /r <br /> ❑ LIFT STATION SIZETYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) V <br /> IVLEACH LINE #OF LINES: a LENGTH OF LINES: , aIETANCEroNURER; wELL�, FOUNDATIONZ.5 (PROPERTY LINE <br /> INFL[TRATOR CHAMBERS: L� <br /> ❑ FILTERBF.D WIDTH LENGTH DEPTH DLSTANCBTONZARER: WELL FOUNDATION PROPERTY LINE R <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEARERT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NBARESr. WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEARER: WELL FOUNDATION PROPERTY UNE <br /> ) <br /> SEEPAGE PITS N C. DIAMETER Si� DEPTH 7-5 0W- ANCE TO NZAREM:`r WELL FOUNDATION 2S _- pRDPFRTN LIN-- q- - <br /> 1 HEREBY CERFIFY 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 JOAQUIN COUNTY. <br /> ill 1114, M 2I 111,11 idV DICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)469-3421 <br /> SIGNED; TITLE: DATE: S^d Z <br /> 1 � r <br /> -�'1-7 <br /> —I - <br /> �IQ Q <br /> ' I s <br /> I I 1 <br /> DEPARTMENTSF.O LV <br /> APPLICATION ACCEPTS BY: rrDATE: d REAy21,EMPLOI'EE IDM" C ISTRII LOCATIONV <br /> INSPECTED BY: DATE: !6 "''�Z' PERMIT FINAL YES DATE: NSpECI'U <br /> COMMENTS 64, IQ S It-77--Z St T6, ISIr—AA,5T C64D T-t, It, 61J 2UIf?� AZO <br /> jj-*L.,,4 MAW,17A J& <br /> — <br /> PL(' UL SC INro I AMOUNT CHECK ASH RECEIVED DATE PERMRISERWCF.RE TM INVOICE+ SEPTIC IDM <br /> REMTRED BY <br /> `{2i 33d Yss3 �51foajl93o <br /> REVISED-1101 _.._.._............................................._. <br />