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L1QUJD WASTE PERMIT.-7 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES E%VIRONMENTAL HEALTH DIVISION <br /> oxo c.V//JA�� C/� 304 E.WEBER AVE Y°FLOOR,STOCKTON.CA 9520E(200)461_)420 <br /> JOB ADDRESS 1A- 1-VKIG1 po5A UN-REFUNUnBLE PERMIT EXPIRES I YLA�PRO" +I.SSUF.0 PARCEL 3178,l S� <br /> wPN I`Qy i11 <br /> CITYf7J► A�II 6}A�Y \ BUILDING PERMEFMJ�,�-�P►/_, <br /> OWNER NAME `[�_�SJ� ,CJ�y ADDRESS9524 E 1 RAQu 1�. [A Q�,�`_� <br /> Crrv12IP�o-cAz�11�/or-J �''"-95105 PHONE NUMBER /��� <br /> CONTRACTORDA, T!"51��14.'{.714 i (PN �, ADDRESS w.rL/1i�uaj/Y, W Ay <br /> CITYRJPy 1~,�A CA �'Jl 5-- PHONE NUMBER_ %GLJ7 <br /> I <br /> GEOGRAPHICALINFORMATLON:COORDINATES:X Y TOWNSHIP RANDS SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING.UNITS: <br /> O NEW INSTALLATION .,RESIDENCE. NUMBER OF BEDROOMS: 4_ <br /> RF.PAIRIALDDITION _,1-` ❑ COMMERCIAL <br /> I <br /> DESTRUCTION pop g5VAtW-R60ACF. O OTHER NUMBER OFEM►tAYEES: <br /> Q ENGINEERED'AL.TERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF J':_ PLTISUMP SOIL CHARACTER: —,WATER TABLE DEPTH: <br /> O PERC TM(S) HOW MANY APPLICATION <br /> SEPTIC TANK TYPLMIFG-_GVG CAPACITY NOFCOMPARTMEN7S <br /> ❑ CREASE TRAP TYPeMFG CAPACITY 9 OF COMPARTMENTS <br /> J <br /> ❑ PKM PLANT DISTANCE TO NEAREST: WELL_ FOUNDATION_ PROPERTY LINE a O <br /> D LIFT STATION SIZE TYPE OF N:MP _44.,__- SAN DOIL SEPARATOR(ENCLOSED SYSTEM)_ <br /> ❑ LEACH LINE N OF LINES: LENGTH OF LINES: 00TANCRTON[ARRET: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH-_ )WANC[TON[AR[4T: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIETAIIC[TO N[ARSETT WELL FOUNDATION PROPERTY LINE <br /> O SUMPS WIDTH LENGTH DEPTH D)ETANCITONMIXT: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIETANCR TON[AR[AT: WELL FOUNDATNJN PROPERTY UNtl aaN <br /> ❑ SEEPAGE PITS q DIAMETER DEPTH DIMNCETON[AREET: WELL FOUNOATION PROPERTY LINE Sv <br /> I HEREBY CER'FtFY THAT I HAVE PREPARED THIS APPLICATWN AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. Q A <br /> (��JMIUN�,H�URA <br /> p�Af{CE NOTICE REQUIREDFORINSPECTTO Le. E E CAL 1�9)468-34 ATE. D Q/, <br /> T1'IU(11�i11L-A1-'-- <br /> --- - - -, ► - - f - -- <br /> - - - -- j <br /> _ <br /> T— - -- ------ <br /> 7- <br /> -4-41- - - - - <br /> DEPARTMENT US )N � J <br /> APPLKATION ACCEPTED BY: ``� DATE. REA � .1P40YER IDR--DISTRICT— I.00ATION_—�/ <br /> INSPECTED BY. ri?.v DAIS; c� PERMIT FINAL a YEE DATE:�11)�� INSPE <br /> COMMENTS: -C /./JtJ J -�/'� „�C ,�• '�ZY�"�^-`- <br /> PE CODE SC INTO AMOUNTCH H RECEIVED DATE PExmrrAERVILT R6 EST0. INV(HCRF $RPTIV,IDS <br /> gyp REMITTFJI RY <br /> RevnuowF.al <br />