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LIQUID WASTE PERM <br /> SOAOUFNCOUNTY PUBLIC HEALTH SERVICES ENVIRONMEN ,HEALTH DIVISION <br /> 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(209)4h%-3420 - <br /> NON-REFUNDABLE PERMIT EXPIKES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS [� � rftr f APN O PARCEL SIZE: <br /> - _ <br /> CITYIZIP r� C - BUILDING PERMITA 20 <br /> 1 <br /> OWNERNAME -� J ADDRESS____,_�_�� 1/_ <br /> CITYlZIi' ___ PHONE: NUMBER <br /> CONTRACTOR �/(�. /lt�S t✓ {,LADDRESS�y <br /> CI'FY17,11 PIION'E NUMBt:R����_��r}, <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y_-----TOWNSHIP •• RANGE SEttCTION ... <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: 1 <br /> [�k .N EW-MTAULATION a RESIDENCE NUMBEROFBEDROOMS: <br />' ❑ REPA[R/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENG[NE-ERED/AL.TERNAT IVF <br /> CHARACTER OF SOIL TO DEPTH OF 3':_,,!9 Y?/�{SC PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> C] PERC TEST(S) HOW MANY APPLICATION# J <br /> ❑ SEPTICTANK TYPE/ FG CAPACITY jG'-p � #OI COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY 4OFCOM PARTMENTS } <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE, TYPEOF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r #OF NES:' . LENGTH OF LRINES CJ 1 <br /> e LEACH LINE _ -� nlcrwNceTONEARetiT: WEiLL,� iOUNbATIOh}��_ PROPERTYLiNE <br /> INFLITRATOR"CHAMJ3FRS: <br /> ❑ FILTER BED WIDTH LENGTH OEPTIIDISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ++�� <br /> ❑ MOUNDED WIOTII LENGTH DEPTH DISTANCE TO NEAREST; WELL FOUNDATION PROPERTY LINE �/aJ <br /> I <br /> ❑ SUMPs WIDTH LENGTH DEPTH DISTANCETONEAREIT: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEARECT: WLLI. FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THF';WORK WILL BE DONE IN ACCORDANCE.WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. „ <br /> M IMUM HOUR ADV NCS: NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: �� l'ITLEp,-z DATE: <br /> r <br /> f <br /> I <br /> _ 1_� = _ .. _. - <br /> .._-. <br /> ` I <br /> t <br /> a,. <br /> E <br /> V _.. <br /> .. -F-. J --- ..._. I Cu E <br /> t <br /> -. .. F....._ io <br /> r �3 <br /> 1 . , <br /> : . 3 . <br /> i -F � CI <br /> ._..._..l. . <br /> { <br /> � 1 1 I ! I _ -_,I <br /> I �I ii) -�.. >�- �.. <br /> -_I 3 I I PAI`I_J(JF�CDF�Il�t E�{J!� .....�._ <br /> I <br /> f.. <br /> LHiSF 1 <br /> ff��Sy DEPARTMENT USE ONLY ^/ ri J(�� ' ;"yES:lt,1 <br /> APPLICATION) DY: yw"S �/-`^� DATE: AREA ^• EMPLOYEE ID# 1 3�/ o DISTRICT LOCATION L C <br /> INSPECTED BY: DATE:l" V-(t� <br /> PERMIT FINA(�YES DATE;_// �fJ INSPECTOR: <br /> COMMENTS: 111 <br /> PE CODE SC INFO AMOUNTCASF1 RECEIVED DATE PERMITNERVICFi REQUESTN INVOICEN SEPTIC IDN <br /> REMITTED BY < <br /> 4-21.3 117 32Q; A00 30C} $ <br /> REVISED N-15-01 <br />