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��-DD0 2SIJ LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUJ3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"FLOOR.STOCKTON.CA 95202(209)46R-7420 <br /> /S <br /> _ A EXPIRES <br /> NON-RfFli DAflIFPERMIT FX APPI"R1 FS 1 YEAR FROM DATE ISSUED <br /> yJOB ADDRESS r;2 12- O <br /> C�S <br /> PAR <br /> CELSIZE: <br /> Cfly/7JPBUILDINGPERMITS <br /> OWNERNAME &b f-Z,< C /2 <br /> CIY7JP PHONE NUMBER -,� Q <br /> CONTRACTOR a/L/ <br /> az- ADDRESSCITY/ZIP e-4- PHONE NUMBER�7 <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> TYPE.OF SEPTIC WORK: �IN/STALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> 1{ <br /> NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: - <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION O OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TESTS) HOW MANY APPLICATIONq <br /> SEPTIC TANK TYPEJMFG �Y.'S" L-/ CAPACITY IZ616 #OFCOMPARTMENTS_,Z— <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY 0 OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> A OF LINES: 1 LENGTH OF LINES: �_�r T y�QF/ E <br /> �I LEACH LINE DI<TAnCc rO ntARttt: WELL 121 FOUNDATION PROPERTY LIN <br /> /\ INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH .1TANCIT.-A.tt: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH -An TTONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DI AnCETONEAR&<T: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH oSTAnCE TO NEAR— WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS M DIAMETER DEPTH D1.4TANCITONEARGCT: WELL FOUNDATION PROPERTY LINE �J <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 /> / INIMUM 24 HOUR ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 v <br /> � � - � DATE:SIGNFU: <br /> 014 <br /> -qTli 7Q <br /> PUI LIC 01 TH 75am I ♦ SZ <br /> :I P <br /> Awl- <br /> I <br /> I <br /> DEPARTMENT <br /> APPLICATION ACCEPTED BYAREA_Ifr EMPLOYEE IM �DISTRIC4LL0CATON-!?7' <br /> INSPECTED BY: DATE / O PERMIT FINAL*YES DATE: INSPECTOR: <br /> COMMENTS: <br /> PE CODE SCINFO AMOUNT iECKI ASH I RECEIVED DATE PERMITSERVICE REQUESTI INVOICEI SER&IDI <br /> REMITTED By <br /> 1 ? 326i0 G LIa ? z,?l D S <br /> REVISED I-IS-01 <br />