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2scJLIQUID WASTE PERMIT <br /> SAN JOAQUIN COU <br /> n DDO NTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION /� <br /> 1k\l 304 E.WEBER AVE 3""FLOOR f V- <br /> STOCKTON,CA 95202(209)43420 c-r 1^�,.�1�1 _ <br /> {4 %- , .J YV <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS :;23[ A ,1����� – A. Z1/3 11/D^O PARCEL SIZE: <br /> CITYlZIP� iQy�C BUILDING PERMIT Nf� ��f/ { `�r� ,'/ /1� <br /> JAG r�IJCs ADDRESS o2 Zoe U�i�/7/ ,e <br /> OWNER NAME <br /> CITY/Zlp ��i /���C G/'T�/ PHONE NUMBER /�� /Q�t O '7- <br /> CONTRACTOR f/ / �( �Q/� ADDRESS_-7�-1'/+���yO� �T��C_/��/ fJlt/L•r <br /> CITYIZIP B1r, �4- �// PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> YNEW INSTALLATION -i RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> O 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 /> -SEPTICTANK TYPE/MFG CAPACITY #OFCOMPARTMENTSc_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OP COMPARTMENTS <br /> ❑ PK(i FX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) _ <br /> �t F FOUT <br /> #OF LINES: LENGTH OF LINES: Z! F/ E��-f <br /> lil LEACH LINE DEti7Ance TO NEAREST: WELL � NDATION PROPERTY LIN <br /> '\ INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DLSTMCK TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIRTANCETOt4"REST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTMCETONEARMT: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DLSTANCETONEAREST: WELL FOUNDATION PROPERTY LINE r0 <br /> W <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,SPATE LAWS \. <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. /V <br /> INIMUM 24 HOUR ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: /,�• /i TITLE: DATE: <br /> DATE: <br /> GA <br /> U <br /> I <br /> OL T4 <br /> PU LIC EA H''RV lb, T \ SL <br /> �i <br /> I _ <br /> U I <br /> t <br /> i <br /> DEPARTMENT <br /> APPLICATION ACCEPTED BY: (7� ��—_IIITEeof/l��–IE..IT.NAL*..Y�ESDATE:—INSPECTOPL DATe: SO AREA�,If EMPLOYEE IDN DISTRICT05 LocAT10NINSPECTED BY: �� '7"�� <br /> COMMENTS:_ _ <br /> PE CODE SC INFO I AMOUNT HECK+,.ASN I RECEIVED DATE PERMIT/SERVICE REQUESTN INVOICE# SEPTIC ION <br /> REMITTEDIly- <br /> 101 <br /> - 1/1 320101 Y q <br /> REV ISED LR-0I <br />