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LIQUID WASTE PERMIT <br /> ' SAN 1OAQUIN COUNTY PU$LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E•WEBER AVE 3°'FLOOR,STOCKTON,CA 95202(209)468.3420 <br /> I NON-REF11BLE.PERMIT EXPIRES 1 YEAR FROM DATE ISSUED !•� <br /> JOB ADDRESS l`o.o �s U � �� APN L� PARCELSIZE: — <br /> CITV/Z1P__ BUILDING PERMIT# <br /> OWNERNAMVL- , ke—, +QMuI_ ADDRESS �39f <br /> CITYlZIP PHONE NUMBERS� <br /> CONTRACTOR I�J�AA� j ADpRESS_q` 1 <br /> CITYrLIP --- [L 2- J PHONE NUMBER qW q~,f 77c2 <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X .• Y -,__ TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> EPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ESTRUCTION ❑ OTHER <br /> Cl ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3':_ PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY APPLICATION <br /> SEPTIC TANK TYPE/MFG C_ CAPACITY-29VI70 4 OF COMPARTMENTS�� <br /> ❑ GREASE TRAP TY`F/MFG CAPACITY N OF COMPARTMENTS <br /> r <br /> ❑ PKGT'X PLANT DISTANCE TO NEAREST: WELL. FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r <br /> LEACH LINE OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELLIbn r FOUNDATION- PROPERTY LINE ©� ' <br /> INFLITRATOR CHAMBERSr <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DISTANCE TONEARE4'r: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTHDISTANCE TO NEAREST! WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DL9TANCETO49AREST: WELL FOUNDATION PROPERTY UNE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH D49TANCE TO NEAREST: WELL FOUNDATION +��' PROPERTY LINE <br /> DEFTH 2 DIPTANCE To NEAREST: WEL 2L r 4' FOUNDATION L4J ' PROPERTY LINE <br /> SEEPAGE PITS �� DIAMETER� ' � LL_ � <br /> 1 HEREBY CERTIFY 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 REGULATIONSOF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR A JOTICE REEPUIRED`fOR INSPECTIO s- EASE CALL(209)463-3423 <br /> SIGNF. V�I'✓61+► fit��` T[ DATEcc <br /> �O'dZ <br /> ; <br /> V716- <br /> _ II � <br /> I ! <br /> IV Ir I <br /> I 4-1-id <br /> 1)F:PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY: I flp8 r=CTr=n RIMEANOTEMPLOYEE IDN DISTRICT_ LOCATION <br /> mT tom+ v-vsf i <br /> INSPECTED BY:_� n1 w/I�►, �- ��/J��/// -DATE: Sj�INALO YESDATE.- INSPECTOR: <br /> COMMENTS:,_ILIL 1/"�-��L_ O'n <br /> PE CODE SCINFO AMOUNT CHECK#/CASH RECEIVED DATE PERMITISERVICE REQUEST# INVOICE# SEPTIC IDN <br /> REMITTED BY ' <br /> REVwD&-IWt S O V Z 9 5 3 <br />