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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTALHEALTH DIVISION <br /> 304 E.WEBER AVE 3"FLOOR,STOCKTON.CA 95202(209)4/rN-1420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISCUED W^ JOB ADDRESS �7 /J37� APN -'??1/�fAQ?�D�D.�/'� PARCEL SIZE: <br /> C1TYIZIP C-11 <br /> BUILDING PERMIT p V w ?2 <br /> OWNERNAME_3Z . E�F"^��/, h�/'�•hG� ADDRESS , <br /> CITYIZIPl�G�.✓ [�iJ Qp / PHONE NUMBER <br /> CONTRACTOR /cl•i�Z. ��"G l`. ADDRESS ,-SAS <br /> CITYIZIP PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X' Y TOWNSHIP RANGE SECTION <br /> �TwYPEOFSEPTICWORK: INSTALLATION WILL SERVE: 1� NU `$ OFAl,IyN�, <br /> pt NEW INSTALLATION ❑ RESIDENCE <br /> ❑ REPAIR/AD0ITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYE ;.,y��••� <br /> O ENGINEERED/ALTERNATIVE �?erMit n1Hy have PY�JIrP+��"'lUu` <br /> .:,._,,c. ,�69n1�1 <br /> lP#at1 nr inspected <br /> CHARACTER OF SOIL TO DEPTH OF 31: .PIT/SUMP SOIL CHARACTER: 33 H! <br /> �,❑( PERCTEST(S) HOW MANY APPLICATION <br /> I �q <br /> SEPTICTANK TYPE/MFG V4 1� CAPACITY #OF COMPARTMENTS O/ <br /> r ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTTSS <br /> ^ I <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE r <br /> ❑ LIFTSTATION S1ZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> � !� <br /> ❑ LEACH LINE #OF LINES: n�f_LENGTH OF LINES:/ DItTANCe TO N.A.: WELL FOUNDATION PROPERTY LINE <br /> I INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTN LENGTH DEPTH WSTANCETONEAREAT: WELL FOUNDATION PROPERTY LINE �a1 <br /> ❑ MOUNDED WIDTH LENGTH DEPTH 01WANCET0 NEAREST: WELL FOUNDATION PROPERTY LINE 'vV <br /> i ❑ SUMPS WIDTH LENGTH DEPTH DIETANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ( .0 DISPOSAL PONDS WIDTH LENGTH DEPTH plbT'ATKf TONCAAEtt: WELL FOUNDATION PROPERTYLINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DMTANCETONEARERTt WELL FOUNDATION PROPERTY LINE <br /> ,erEf1 HEREBY CERTIFY THAT i HAVE PREPAREDTHIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> I AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUIV 24q�ADVANCE T10E REQUIRED FOR INSPECTIONS-PLEASE CALL(209)469.3423 <br /> SIGNED: !.C/J✓�3/ TITLE:_ -0ATE:I�J <br /> — 4 - ;— <br /> lit- <br /> - <br /> Wit--- <br /> _ __ _ _ _ __ t : +_ <br /> - -- - � E - <br /> - - - - <br /> t 1 L— - pI"��ac�ar u _7 - <br /> 1 M NIML HOALTOO .SYOII j <br /> DEPARTMENT .�., . <br /> ��'�PFL(CATION A EPTED8'Y,:�•�C [/�� � JIDN�DISTRI _LOCAT{ON J <br /> INSPECTED BY: ��F•-i.— ^-' '�-0le DATE: PERMITFINALO YESDATE: INSPECTOR: <br /> • COMMENTS Q - � <br /> I 41A GvrrtaKee. <br /> PECODE SC INFO AMOUNTCHEC N RECEIVED DATE PERMIT/SERVICE REQUESTN INVOICEN SE IC IDN <br /> REMITTED Ry <br /> zJr20 D72, ��a sj 0�31(l5 W <br /> REVISED R•If.bl � - <br />