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�ry <br /> LIQUID WASTE PERyq, <br /> _e JOAQUIN COUNTY PCj3LIC HEALTH SERVICES ENVIRONM I.HEALTH DIVISION <br /> - 304 E.WEBER AVE 3x"FLOOR,STOCKTON.CA 95202,­,T;0-3420 - - <br /> iY <br /> N ND LF PERMIT EXPIRES 1YEEAR FROM DATE ISSUED <br /> JOB ADDRESS � r APN - f{Q <br /> `�/ I I �j ✓ PARCEL S1Z G <br /> CITY/ZIP w/ /}/ �nBU1LLDDING PER+MITT## <br /> OWNERNAME���K/rIV� F'V !//'� f�1""D • �� [%i ` � CJC✓C✓Y-� .. <br /> CITY/ZIP_ � I _ PHONE NUMBERCf/ <br /> CONTRACTOR ��� _`� ADDRESS <br /> CITYIZIP /�!G FG �! 7, IC3 PHONE NUMBERol <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIPUADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> 0 ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PiTISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> PERC TEST(S) HOW MANY­2r�)APPLICATION <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFIMFG CAPACITY #OF COMPARTMENTS r <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE C' <br /> ❑ LIFT STATION. SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑. LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE- <br /> E3 <br /> INE r <br /> " r <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCRTONEARE.4: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH - LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 'c ` <br /> ❑ SEEPACE PITS # DIAMETER' DEPTH - DISTANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE <br /> 40 <br /> I HEREBY CERTIFY THAT 1 HAV PREPARED THIS AP KATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS <br /> AND RU AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMUM 2 E NOTICE REQUIRED FOR INSPECTIONS-PIEASE�C^ALL(209)46688-�•-334�423- <br /> SIGNED: TITLE: ?(, 71✓/ DATE: <br /> : <br /> 17. <br /> € ; <br /> 1... <br /> t 1 I 571 <br /> I - <br /> I <br /> . .-. I ...,...} ... i,.., t -...... - <br /> r � # <br /> PUG.IZ.Reg2 10:03W <br /> STOCKTON WHGLESnL N0.311 P.2r2 -- r1{I J�P <br /> I I. <br /> 4 <br /> .4 .JJG.yJ 2 <br /> ,...» --, T 1 - i F,_ j y• cN r �;tiS w e �.� '; u y,} a ,.,o bti '� . <br /> ..,.-._1 1 I �, 1 I -:...mw sA��`"1- ��5.� y n \%O 4 M1' A O= y; .a C L� - I I. il__A`..a' <br /> j4 "� ` �� rq 3.53 !M1 n3a y. n a m P ' I <br /> �9e I f*N�4 1 I <br /> ._.,..._ ai <br /> Q `9 94 y r4'.r9 rte?2a .e a I---_e CE <br /> • <br /> ' i i a A t e R U a o - - <br /> r <br /> ? - <br /> I �S€ <br /> .. <br /> } g{ 0t�tyy -.,. I <br /> j <br /> I I <br /> I- I II <br /> f 1 1 <br /> ' U <br /> nFPARTME T USE ON Y <br /> APPLICATION ACCEPTED BY: DATE: w AREALOYEE I DISTRICT LOCATION <br /> INSPECTED BY: / -DATE: O=— PERMIT NAL CI YES DATE: INSPECTOR: <br /> COMMENTS .� O�; f-,6U�f �l"I'� • �, - ?lr �. Lu4S GY �tzn IWYY- o4'�gY1.C: <br /> r <br /> s <br /> PE CODE SC INFO AMOUNTCHECK# ASH RECEIVED - DATE PERMITISERVIC£REQUEST# INVOfCEh -SEPTIC IDA <br /> REMITTED BY - - <br /> �zz 5z ��� 11 �� z� �� � ���oo��o � w�- - -• � <br /> REVISED 84141 - <br />