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4 LIQUID WASTE PERMIT <br /> SANIOAQUN COUNTY PU.BLK:HEALTH SERVICES ENVTRONMENTALHEALTH DIVISION c%,=PTIC <br /> ` 301 E.WESER AVE 3R0 FLODR.STOCKTON.CA 952021209)4611.3420 - v <br /> No -RI.F0ABLE PERMIT EXPIRES I YEAR FROM DATE I/SSUED <br /> JOS ADDRESS APN�?O i�'�-2;;`/0/© PAfiCEL S17JS /'/G�"L�S <br /> CIlY1Z1P_ BUILD NGPERMIT <br /> C? / .•. O3 S _ <br /> OWNERNAME pe r rP I ADIMISS 7 V.7.J P�FSIV IA/(. 12 C6 <br /> CITYfZIp � - ✓//3 - <br /> PHONE NUMBER <br /> CONTRACTOR hJjS I <br /> ADDRESS <br /> CITY2IP _ PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X -Y--TOWNSHIP RANGE SE(,TfON <br /> FTV F OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNI <br /> TS_ <br /> 1�°j[NEW IPJADDl ION RESIDENCE <br /> ❑ REPAIR/ADDITION NUMBER OF BEDROOMS: <br /> ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBEROFEMPLA)YEES: <br /> ❑ LINGMEEREDIALTERNATIVE <br /> I <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TRSI'(S) HOW MANY APPLICATION# <br /> Cl SEPTICTANK TYPE/MFG CAPACITY 0 O COMPARTMENTS <br /> Q GREASE TRAP TYPE/MFG CAPACITY #OF COMPAIRTMENTS <br /> ❑ PKCFX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE_ <br /> O LIPTSTATTON SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O' <br /> LEACH LINE #OF LINES:�L[NGTH OF LINES:_ DWANR TO 14P.IRER7,: WELL FOUNDATION PROPERTY UNE <br /> INFGTRATOR CHAMSERS: <br /> 13 RLTER BED WIDTH <br /> LENGTH DEPTH—_— DbTAN06IONLARIDT: WELL FOUNDATION PROPERTY LINE <br /> CJ IHOONDED WIDTH LENGTH DEPTH--_ D ANQ'TDNUADFT. WELL FOUNDATION PROPERTY LINE <br /> O SUMPS WIDTH LENGTH DEPTH DncrANa TDNEARLST. WELL FOUNDATION PROPERTY LINE <br /> Q DISPOSAL PONDS WIDTH LENGTH DEPTH DILTAN"TO NEAREST: WELL FOUNDAT)ON PROPERTY UNE <br /> SEEPAGE PIIS # DIAMETER �iJ DEPTH DI MCK TO NlMuwr. WELC POUNDATON PROPERTY LINE <br /> - <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WALL BE DONE IN ACCORDANCE WITH SAN JOAQUN COUNTY ORDINANCE$STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(X09)4W3423 <br /> t/ _TITLE: DATE: l'- I� <br /> T- <br /> ---L-- I � <br /> 1 711 1 1 1 1 01 <br /> I <br /> • � � r 1 -1-1_ � - -l'-�- Y--t•-'- •�--�--+--^•--ice-�-tt-I <br /> 4-- <br /> i .. <br /> -I I --�-T --�- <br /> 1 I <br /> I 5,r1 E'-..T__;^�_-' I _-�- F �•'�P`."'F.i'FI�tL�.rl»A. <br /> I 1_ <br /> -- <br /> OEPARTMENTUSEO, ,Y <br /> APPLCATION ACCEPTED BY: DAT; cy/S AREA EMPLOYEE ADIsAf .I&MICT_ <br /> —IACATiON_ <br /> INSPEED BY: DATE: /U PERMIT FINAL; ES YDATE <br /> CTINSI'ECPOR: <br /> OOMMENTS: <br /> PE CfiDE SCINFO ANOINT CHECK ASH RECEIVED <br /> By DATE PERMIfSE E54 RlVOICFA SEPTC IDP <br /> R NIttTiD <br /> IV- <br /> R6Y19ED�•134I i <br />