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LIQUID WASTE PERk <br /> SANJOAQUINCOUNTY PUBLIC HEAL-Qi SERVICERENVIRONME L HEALTH DIVISION <br /> y r 304 E.WEBER AVE 3"FLOOR,STOCKTON,CA 95-202(2D9)4414-3420 <br /> -REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATIE ISSUED <br /> SS <br /> JOB ADDREAl.R oz N �U APN (.�7 7"' �r+'�-� 1� <br /> �.jf _�/f q/ PARCEL SI7.F.- <br /> : <br /> (:ITS'/ZIP �,1 t r it v�/� BUILDING PERMIT X � �-- <br /> OWNER NAMI, �L A ��[L ADDRESS �- 1 L <br /> CITY/ZIP—._ /. PHONE NUMBER t J-01) <br /> CONTRACTOR_Caq.l-r-06 f -{ I/lr ADDRESS_ 1/j 5f <br /> CITY/ZIP �u�7 _ L, {Z� PHONE NUMBER l aLV7 1- -�3 y•�� -_ <br /> GEOGRAPHICAL INFORMATION:COORDINATIESr X _ Y TOWNSHTP_--_RANGE__SECTION- <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBK+R OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RLSIDENCF. NUMBEROFBEDROOMS. —� <br /> LlREPAIR/ADDITION COMMERCE <br /> ❑ DESTRUCTION PLOTHER ,p NUMBER OF EMPLOYEES: 41 __ <br /> Cl ENGINFEREIVALTERNATIVE <br /> CHARACTEROF SOIL TO DEPTH OF 3':— PITISUMP SOIL CHARACTER; WATER TABLE DF:1.1 I1: <br /> ❑ PERCTEST(S) IIOW MANY APPLICATION#_ <br /> SEPTIC TANK TYPFJMFO_ cowP Cc{>P _ CAPACITY 114e,70 4OFCOMPARTMENTS <br /> �— <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZF. TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> #OF LINES: L LENGTH OF LIN LEACH LIVE mRTANC[TO N[MLtT: WELL FOUNDATION PROPERTY LINE__ <br /> 1NFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTIi_ DISTANC[TO WARFn; WELL FOUNDATION PROPERTYLINE <br /> ❑ MOUNDED WIDTH LENGTH__ DEPTH_ D14TAWK TO NRARctr; WELI. FOUNDATION PROPERTY LINE w <br /> .� SUMPS WIDTH LENGTH DEPTH _ DUTANC[TONEARM: WELL FOUNDATION PROPERTY LINE L <br /> W <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCIRTONRARR.Tr: WELL FOUNDATION PROPERTY LINE <br /> `❑ SEEPAGE PITS # DL4NFTEltDEPTH I:HTANC[TON[AREST: WELL FOUNDATION PROPERTY LINE <br /> I HCREHY CERTIFY THAT A VE P ED THIS APPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN WUNTV ORDINANCES.STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M1Nl HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(�)"11.34t1 <br /> SIGNED: TITLE: DATE: —6—e—Q, <br /> 1 <br /> ...E .. <br /> . r 7p� <br /> : <br /> ITT <br /> N I <br /> a <br /> 1 <br /> - - <br /> . <br /> i <br /> IY - <br /> I I <br /> 1 <br /> I <br /> , <br /> DEPARTMEN/T�U ,.r,4•{, -,�u.r V ,QI;(n�:D:.,, qQ <br /> APPLICATION ACCEPTED ADA-T..:_�r ARF.A�.! /—LMPLOYEE 10X 1 DISTRICT LOCATION / <br /> INSPECTED BY: __-DATE-jv-`I'-O2 PERMIT FINAL VYES UATE:. INSPECTOR:_ <br /> COMMENTS: <br /> LWE Ge 'L •' -Tr+r 3Z f�4"m 54A$ ?cWtia''stae. , <br /> PE CCDF. $(-INFO AMOUNT .#ECRB: H RECEIVED DATE. PERMITKF.RVICE REQUESTR IN ICER SEMIC IDR <br /> REMITTED OY <br /> '12-11 w7 AA3 <br />