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• LIQUID WASTE PERMIT DI <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEA. VISION L `� D) <br /> 301 E.WEBER AVE I-FLOOR,STOCKTON.CA 95201(_'09)469-2420 <br /> NUN-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE 155VED <br /> JOB ADbRE56 ' 'aJL) — `I PARCEL , O-21RO S 1%4m leaO"'JQ CA ► / <br /> 003 <br /> GI.I.YrraP '7-%C, C-No? c-,,II S � BUILDINCPERMITI /� ONMENI HEALTH <br /> OWNER NAME (_ JL.IJ� L.Fu@11Y1{ wouaESB u`'-�t7 C) <br /> "A "r'r�n,e Jd UTAIG:'�''"Uw,J tL a� �:7{1"�'�.S,�I�lEf111 I1�ES <br /> 6 13 <br /> CITVrIIP wY"�'�G-1C.�40rA C A, f�041 PHONE NUMBER 441'�� , <br /> CONTRACTOR 52 L"*Sle�• ADDRESS <br /> crrvtLIP PHONE NUMBER LA 1)(p—0 <br /> GEOGRAPHICAL INFORMATION:COORDINATES;x Y TOWNSHIP RANCE SECTION <br /> TYPEOFSEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION 4 RESIDENCE NUMBEROF BEDROOMS: <br /> 0 REPAIRJADDITION % COMMERCIAL NUMBER OF EMPLOYRES: <br /> O DESTRUCTION ❑ OTHER <br /> — <br /> 0 ENGINEERBO)ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISIIMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTESI'46) HOW MANY APPLICATION <br /> Q SEPTICTANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS r <br /> ❑ <br /> GREASE TRAP TYPE/MFG <br /> C•ApACI Ty 6OFCOMPARTMENTS— <br /> CI PKGTX PLANT DISTANCE TO NKAREST: WELL FOUNDATION PROPERTY LINE <br /> i <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> J / <br /> (3 LEACH LINE NOF LINES: 2- UNGTH OF LINES: �f1 pIATAN¢mmm"aT: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTERBED WIDTH-- LENGTH DEPTH DIETAN=TONEAR ; WELL' FOUNDATION PROPERTY LINE , <br /> ❑ MOUNDED WIDTH_— LENGTH DEPTH DIbTANCE TONFAREIT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH_ <br /> IDTH LE CS DEPTH DIFTANCZMRSARUTI, WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENOTH OEM PWANCITON1AIDR: WELL FOUNDATION PRO►ERTY ONE <br /> ❑ 6EVAGE PITS O DIAMETER DEPTH DInTAN01 TO H(AREBT. WELL FOUNDATION PROPERTY UN¢ <br /> 1 HEREBY CER71FY THAT 1 HAVE PREPARED THIS APPLICATION <br /> AN H W0IUK WILL <br /> LLS E DONE SAN INAACCORDANCE Q IN COUNTY, RH SAN JOAQUIN CYJUNTV ORDINANCES.STATE LAWS <br /> o MIMMv,h 224 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)46"23 <br /> SIGNED: 4i."",-..�- TITLE: (1..a1t"'�C. DATE: <br /> 4+11 <br /> I <br /> SA J AQ IN <br /> tic ,Aa in <br /> �} 1�/^I DFPARTM ENT USE ONLY "� Q't _ <br /> �/• I�41.1h`1��L\.. DATE: M1 - 1A)t �� EMPLOYEE IDN I.�V`� DISTRFCT tL—LOCATION <br /> APPLICATION ACCEPTED BY: Yw <br /> r <br /> DATE: PERMIT FINAL❑ YES DATE: INSPECTOR: <br /> INSPECTED BY: <br /> COMMENTS: <br /> I <br /> ID <br /> DATE PERMRiSFAVICE REOUEl11P INVOICE/ �EPTIE P <br /> PECODE SC D RNMIITT D 14`E•�^ ASM R B <br /> ��.-►i� X15" i�Q �.c.)�x �' f� /iti' f::%•,y•'�t'��:1�7 � 5 <br /> RLVIRE0415-0I <br />