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UQU1D WASTE PERMIT <br />SAN JOAQUIN COUNTY PURIA: HEALTH SERVICES rwrRONMENTAL HEALTH DIVISION <br />304 E WEBER AVE 3"' FLOOR. STOCKTON. CA 95202120914W3420 <br />NON-REFUNDABLE. PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />SC INFO <br />J <br />JOBADDRESSSS1"Y �, <br />APN-AV-7--•0d4-.-L- PARCEL SIZE:O <br />DATE <br />CITY/ZIP_ SFE-JAM/..1r!� <br />BVILDINGPERNITM <br />1+� <br />Jr811 <br />1 <br />OWNER NAMEd" ! <br />ADDRESS <br />;PIx13o — <br />CITYIZIP <br />PHONE NVNIBER <br />--- <br />/ J <br />CONTRACTOR <br />ADDRESS <br />CI'1'Y7ZIP <br />PIIONF.NI!AIBER y�yra 7 <br />GEOGRAPHICAL INFORMATION: COORDINATES X. <br />Y TOWNSHIP RANGE SECTION <br />TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br />❑ NEW INSTALLATION PD- RFSIDENC•L• <br />NUMBER OF BEDROOMS: _ate <br />Oa^ REPAIPUADDITION ❑ COMMERCIAL <br />O nFSTRUCTK)N ❑ OTHER <br />NUMBER OF EMPLOYEES; <br />O ENG[NEEREDIALTERNATIVE <br />CHARACTER OF SOIL TO DEPTH OF3': Sde-c/ PIT/SUMPSOILCHARACTF.R: 5.1:M/ WATER TABLE DEPTH:— <br />❑ PERCTEST (Sp HOWMANY— APPLICAT•IONP <br />1 _ <br />LS- SEPTIC TANK TYPEJMFG S.taC� _ <br />CAPACITY l X� #01'COMPARTMENTS <br />❑ GREASE TRAP TYPE:MFG _-- <br />CAPACITY #OFCOMPARTMENTS <br />❑ PKGTKPLANT DISTANCE T'ONEAREST! WELI_�tlf <br />FOUNDATION PROPERTY LINE /y, <br />❑ LIFT STATION SIZE TFZDFPUMP _ <br />SAND OIL SEPARATOR(ENCLOSED S YST EM) <br />&-LEAC.H LINE P OF LINF.S: - _-I_ LENGTH OF LINES:_ yQ � <br />plsiAVL-E iD NeAREsr: WF.IJ d'I• FOLNDA710N_JTL PROPERTY LINE. /y , <br />INFLITRATOR CHAMBERS: <br />❑ FILTER BED WIDTH LENGTH DEPTH_ <br />pISrAYCR TO NEARPF.r; WELL FOIINDAI'ION PROPERTY LINE <br />U MOUNDED WIDTH LENGTH DEPTH__ <br />DISTANCE TO NEAREST, WELL FOUNDATION PROPERTY LINE- <br />❑ SUMPS W'IIjTH LENGTH DEPTH__ DIeTANCETONEAREST: WFI.t FOUNDATION PROPERTY LINE TT <br />❑ DISPOSAL PONDS WIDTH LENOI'H DEPTH Di T.ANCLTONEARER; WELL FOUNDATION PROPERTYLINii <br />SEEPAGE PITS _ D41Nk1ER ' DEP1H DUTSNCE rA NEAnnr: WELL FOUNDATION PROPHRIY LINE L \ <br />I HEREBY CERTIFY"f HAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DOVE. IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANC ES, STATE LAWS <br />AND RULES AND RF.GL'IAT•IONS OF SAN JOAQUIIY COUNTY. <br />MINIMUM 14 HOUR ADVANCE NOTICE REQUIRED FOR iNNPECTHYNS - PLEA§E CALL (204) 469-3423 <br />SIGNED: - JTITLE:_lu� it DATE: i G Z L" <br />. ; 1 <br />1 <br />._ ._:....4....4,..�._,.� <br />: <br />1 <br />1 i <br />} <br />• 12 i <br />�i c � •i <br />jev <br />A4 11A. <br />y...:. �...7 .. <br />- <br />:y <br />..... __..... .... _ - <br />. 1 <br />• I iT <br />. . <br />- � 1 <br />,;UInIJL.'111IJt'� .}. <br />. ; <br />i. we <br />I'4VIIf P1. Nii! .t!: �..i`:j,5fi!_. �Y' I ! I .... <br />i. <br />�. <br />/) DEPARTMENT U'E NI -Y <br />APPLICATION ACCEPTF DY' GATEJ�/J �REAEMPLOY EEIDN Q DIS.I /—LOCATION—" <br />INSPkI'IEO BY. .. DATL: PERMITFINAL4 YESD.ATE. "2'604S?,rl TOR: <br />COMMENTS -12.- 4-07 N61d Tt}UK ilFiJfNI.Mx S f j'•L L�[ �� dpi!' _ •�, /� <br />6.ec G� .d �, /2 •Q••r.� <br />PE NDE <br />SC INFO <br />AMOUNT <br />REMITTED <br />C'HCCKw ASN It EIVEJT <br />BY <br />DATE <br />PER MIT.•SERSTCEREOUESTe INVOICEV SEPTIC or <br />a <br />1+� <br />Jr811 <br />;PIx13o — <br />;EV[4[D A.Iiel <br />- <br />--- <br />