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LIQUID WASTE PERMIT - <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DfVISION SEPTIC <br /> 304 E,WEBER AVE 3P°FLOOR,STOCKTON,CA 95202(209)"6 3420 <br /> f YON- F.FI:N'DA {,E pF,RN IT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS a APN �'^O� <br /> c/7� PARCEL 917�:�_�� <br /> CFTytylP_ L BUILDING PERMIT <br /> OWNER NAME <br /> ADDRESS�S-�1. f0��-i <br /> CITYIZIP�E PHONE NUMBER f Lam" <br /> CONTRACTORL k <br /> t ADDRESS 77 f <br /> CITY(L{P 11 <br /> PROVE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X_ TOWNSHIP RANGE SECTION <br /> pppTYPE OFSEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF IYINCn UNITS: <br /> }7�7 NEW INSTALLATION RESIDENCE <br /> r❑_REPAIR/ADDITION NUMBER OFTEDROOMS: <br /> ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYERS: <br /> ❑ ENGDJEERED/ALTEI(NATiVE <br /> CHARACTEROF SOIL TO DEPTH OF3':_ PfTlSUMP SOH,CHARACTER: <br /> WI019RTABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY 1( APPLICATION# <br /> SEPTIC TANK TYPEIMFG_ CAPACITY #'IF COMPRTMEMIS <br /> ❑ GREASE TRAP TYPE/MFG Cl <br /> #OF COMPA RTMENTS <br /> ❑ PKGT3(PLANT DISTANCE TO NEAREST: WELL. FOUNDATION <br /> PROPfiRTV UNE <br /> El UPTSTATION SIZE TYPE OF MAW SAND OIL SEPARATOR(ENCLOSEDSYSTEM) <br /> Ii. LEACH L1NE #OF LINES: LENGTH OF LINES:--:T-- <br /> :T Dw� NL. WELL POU14DATION PROPERTY UNE <br /> 1 fNFUTRATOR CHAMBERS: —�" � <br /> ❑ FILTER BED wiDTH LENGTH DEPTH DIArA TONL4mwr. WELL FOVNDAT.'ION PROPERTY LINE <br /> ❑ MOUNDED WIDTH <br /> LENGTH DEPTH DIRTANR TTI NPJ1aH1taT: WELL F <br /> OVNDAI:ION PROPERTY UNE <br /> ❑ SUMPS WIDTH LENGTH DEPTH­ DIWANLYTONtl lwr. WELL I <br /> • FOUNDATION PROPERTY LIRE <br /> ❑ DLSPORAL PONDS WIDTH LENGTH DEPTH � INATAMCETONFAAMr, WELL FOUNDATION PROPERTY UNE ^ <br /> SEEPAGE PITS #_ DIAMPTER DEpTK?s7 r NMMCBTONH:APIISr' WELL FOUNDATION PROPERTY LINE 1y� <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUICATION AND THE WORK WILL BE DO <br /> AND R1N ACCORDANCE W17H SAN JOAQUIN OOUNTY ORMNANCLS,STATE LAp•S <br /> L'I,FS AND REGUIwT'IONS OF SAN JOAQUIN COUNTY, <br /> ICNED: MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 09)468-3423 <br /> -rti+-✓ �� TITLE: DATE: <br /> i <br /> : <br /> -r . <br /> _'1- _.. _ I <br /> -�--1.- ��; •1--i��_-a_ 1,L � i -�---�_-j._�•4--�-_.r-�-f_�--_:-_,i�T ' I i I I <br /> 1 i II 7 <br /> I APPUCATION AOCEPFFD B <br /> DF.PARTM£NT U <br /> D �E• _ <br /> ARE EMPLOYEE 1-4W- S1•RI LOCATION_ <br /> INSPECTED BY: <br /> DATE: '��/C�� PERMIT FINA�ES DATE. f INSPECTOk <br /> COMMENTS: <br /> PE CODE SC IWO AMOUNT CHE H RECEIVED DATE <br /> BY <br /> M PERM UFSII(VDICEY SEPTC ms <br /> REMITTED <br /> •{l l��t 75 1�3, o Sj2005�`�1 <br /> REt'ISED41S11 <br />