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LIQUID WASTE PERMIT <br /> ^� SAN lOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEACI'H DIVISION <br /> 304 E.WEBER AVE 3w'FLOOR,STOCXTON,CA 952021209)4M-3420 <br /> U ^ <br /> -1� �N-OsN-REFL'NDAB PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I J t <br /> ,n}3'�'^ '-"1 PARCEL SIZE <br /> C1TYlZIP_ BUILDINGf[P:EERMIT# LJ �C0 1 TAXI_ <br /> 7� L <br /> OWNER NAME -/- �`� L� n/�i11 A DDRFSS_07_3Ly(__J ,1%0 I 7woo Q� <br /> CI'IYlZIP �c�.......__ C._.� PHONE NUMBER L6 - / 3 '-� i+ <br /> I <br /> C(JNTRACTOR�C /� ADVRESS�- -_ <br /> CITY/ZIP _^ -i•- qs�'3� PHONE NUMBER__.,_ <br /> GEOGRAPHICAL INFORMATION:COORDINATES X _ TOWNSHIP_-RANGF_-_—.SECTION .. <br /> TYPE OF SEPTIC WORK: INS'T'ALLATION WILL SERVE: NUMBER OF LIVING UNITS--- <br /> NEW INSTALLATION p,RESIDENCE 3 <br /> ❑ REPAIR/ADDITION NUMBER OF BEDROOMS: <br /> ❑ COMMERCIAL <br /> ❑ <br /> DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: i <br /> ❑ ENGINEERED./ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3 ___ PIT/SUMP SOI 1,CHARACTER; -WATER TABLE DEPTH: <br /> ❑ PERCTEST(s) HOW MANY APPLICATIONp <br /> JIB SEPTICTANK TYPE-MFQ,vL--LQa--� -CAPACITY Lam}[] 340FCOMPARTMF.NTS Z <br /> ❑ -GREASE TRAP TYPE+MFG_ __^ CAPACITY _ #OF COMPARTMENTS <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST': WELL-1701 <br /> FOUNDATION _ PROPERTY LINE <br /> ❑ LIFT STATION SIZE_,_ TYPE OF i'UMP SAND OIL,SEPARATOR(ENCLOSED SYSTEM) _ <br /> St LEACH LINE #OF LINES: Z_ LENGTH OF LINE& DISTANCETONEAREJT: WELLED FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: ----'— <br /> l� FILTER BED WIDTH LENGTH DEPTH__ DISTANCE TO N.AMT; WELL FOUNDATION PROPERTY LDB___ <br /> U MOUNDED WIDTH LENCTH ___ DEPTH DISTANCETONE"LET: WELL—— FOUNDATION PROPERTY LINE ._ <br /> ❑ SUMPS WIDTH_ LFNCT.H DEPTI Imo_ DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ,�❑p DISPOSAL PONDS WID'TN LENCTII UMY rH DISTANCR TO NEARKS•r: WELT.__ FOUNDATION PROPERTY LINE (� <br /> SEEPAGE PITS u�_ OInMFTF.0._ — DEPTH —TANCETONLAREST: WELL�D _ 1 <br /> FOUNDATION PROPERTY LINE <br /> [HEREBY CERTIFYTHAT I HAVE PREPARED THIS APPLICATION.AND THE WORK WILL BF,DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI IMUR H ADVANCE NOTICE REQUIRED FOR INSPECTIONS- ASE CALL 204)468-3423 _ 4h <br /> SIGNED: _ <br /> _TITI.F.• <br /> � <br /> 4-1 <br /> r- <br /> I — <br /> I I I <br /> --I <br /> 1 _ <br /> DEPARTMENT�`�(E LV <br /> APPLICATION.ACTPTF.O BY', O <br /> DATF -1l' Ij/, EA � GMPLOVCF IDN <br /> DISTRIC-F (LOCATION <br /> C <br /> INSPECT EDBY:� _ --- DATE> FERMI"I'HNAL�YESDATEINSPECTOR: I� <br /> CDMMEMS: ''f <br /> PE CODE SC INFO AMOUNT CHECK(CASH RECEIVED DATE ` <br /> REMITTED 11 PERMITISERVICE REOUESTY INVDICCNEMI[(Da <br /> 00 2J 33 <br />