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LIQUID WASTE PE <br /> �JOAQUIN COUNTY PUPLIC HEALTH SERVICES ENVIRONM HEALTH DIVISION #..<. <br /> 304 E.WEBER AVE 3R"FLOOR,STOCKTON,CA 95202( )469-3420 <br /> '7 �r� NON-RLFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE:ISSUED <br /> JOBADDRESS /UQ ���Gay� �`1�1 //C^- '1 n ` <br /> APN % J rG 3 i (, PARCEL SIZE: L7 <br /> BUILDING PERMIT <br /> OWNER NAME1\( T I ADDRESS c � <br /> {L <br /> CITY/ZIP GANjj 7tL1(," PHONE NUMBER_ 7-� <br /> CONTRACTOR.. F+��LNU t Tia-�G.�ll � g ,( <br /> $�g '� y+ �►DDRESs 1®7iZ l�pa c``�+,r•-^✓ 1 1� �4 <br /> CITY/ZIP 1 (VE/t0 V �� � PHONE NUMBER Z�' ( Zip <br /> GEOGRAPHICAL INFORMATION: COORDINATES: x <br /> --_.__-_--_____Y_ TOWNSHIP RANGE_ SECTION <br /> — <br /> TYPE OF SEPTIC WORK: I <br /> INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION L3 RESIDENCE <br /> ❑ REPAIR/ADDITION NUMBER OF BEDROOMS: <br /> COMMERCIAL <br /> LJ DESTRUCTION ❑ OTHER_ NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF Y: PIT/SUMP SOIL CHARACTER: <br /> _ WATER TABLE UF;P"1'H: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> SEPTIC TANK TYPE/MFG_ CAPACITYIQ-__ #OF COMPARTMENTS �-- <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY <br /> #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL. FOUNDATION <br /> PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINT, <br /> INFLITRATOR CHAMBERS: ] —J <br /> �J FILTER BED WIDTH �J- LENGTH /® DEPTH J�Jr I DISTANCE TO NEAREST: WELL �o FOUNDATION lot PROPERTY LINE /p+ <br /> '❑\ MOUNDED WIDTH LENGTH DEPTH DISTANCETONF.AREST: WELL <br /> FOUNDATION PROPERTY LINT. - <br /> ❑ SUMPS WIDTH _ LENGTH DEPTH DBSTANCETONEAREST: WELL <br /> FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL. FOUNDATION <br /> PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION <br /> PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN- <br /> AND COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMU 2 OU A VANC NOTICE R <br /> SIGNED: EQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> r,G <br /> i y_ <br /> TITLE: 6- F 'j i DATE:_ �' <br /> .}... l i ...._....... <br /> .. , :... 1 <br /> .....,.... ....} I may_✓' rr..... ... <br /> 1� <br /> 71 r <br /> ................ ...... A .. <br /> ..... ♦ ... !.. f r, ... .. <br /> n . <br /> x <br /> y l <br /> N•Rir f { <br /> ............i ) /9fYJ'YL'JA Aiii�'A.tR orcre oc .IAA kt ._ ! y..... t y .... <br /> ., i... .q..... 1 ..... ....', <br /> ..1.....iE <br /> ........ r- ............. <br /> . <br /> .......i nt,r - <br /> 1 .1 .. <br /> ., i ...i 1. <br /> i I <br /> 1 <br /> + A i 1 1 y.. r. / nn IW'/ wrym. ...L ... <br /> ......... ..+ ..........t. ...r.... ;t" r - ` ws.ni.+ar vc A"VIYIL(� .. <br /> --- <br /> ECEAVED <br /> �..it <br /> 11111 <br /> 11 to I I I I I <br /> a <br /> li 'sl .I Imo, t <br /> T <br /> nn <br /> ...:......;... t1 r <br /> »... ., .....i Ir, -�-l; -4-2ttj -- <br /> I,I a r r F LII.jiFAI:TI{SERV(CES .... <br /> ... .t ...,....... .<......._,... ..... .....:. UR <br /> / �s� <br /> i E I 1t�/.... ron I I �L!Vi f'P�F�-If-PiTAI HI lci.11i DiVIS'IOi <br /> i i - .._...____. errr <br /> ' -r <br /> t. <br /> / ur:PAu I HENT USE OyLY p <br /> APPLICATION ACCEPTED BY _DATE: V AREA ;L' EMPLOYEE ID# -(17q DISTRI(-F <br /> (!-_LOCATION • _ <br /> INSPECTED BY: DATE: <br /> - .�I1J PERMIT FINALYES DATE:__ INSPECTOR:___ ' <br /> COMMENTS: <br /> PE CODE SCINFO AMOUNT HECK#/ SH RECEIVED DATE ��- <br /> REMITTED PERMIT/SERVICE REQUEST# <br /> BY INVOICE# SEPTIC IDa <br /> 2' lnllo p 0x76 <br /> REVISED 8-15-01 <br />