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€ i LIQUID WASTE PERNfo' <br /> SAN JOAQUIN COUNTY PU$LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WE13ER AVE 3"FLOOR,STOCKTON,CA 95202(209)468-3420 <br /> F11 .. <br /> NON-RE NDABLEPERMIT EXPIRES I YEAR FROM DATE ISSUEDJOB ADDRESS . J F- APAll' � ,� 1 V �- I - PARCEL SIZE:F,� <br /> CITYlZ1P- Lo c1 r�� A r4.: BUILDING PERMIT# <br /> OWNERNAME1javy ��yCJ�.}-C�i2byer1 ADDRESS �o .� <br /> �`�; CITY/ZIP � � _ PHONE NUMBER <br /> -- I <br /> CONTRACTOR ADDRESS <br /> CITY/ZIP PHONE NUMBER <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 /> eEPAIRIADDITION ElCOMMERCIAL NUMBER O.F.EMPLOYEES: <br /> DESTRUCTION O OTHER <br /> ❑- ENGTNEEREDlALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: V <br /> t i <br /> ❑ PERCTEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTIC TANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS <br /> 1'1 � <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> 1 <br /> - ❑ PKGTX PLANT DISTANCE TO NEAREST. WELL FOUNDATION'S - PROPERTY LINE , <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SANdOILSEPARATOR(ENCLOSED-SYSTEM) <br /> ❑ <br /> #'Of-LiNES: LENGTH OF LINES:LEACH LINE � DISTANCE ioNEAR ESi; WELL FOUNDATION. - ' PROPERTY LINE. <br /> I <br /> INFLITRATOR CHAMBERS: z ' <br /> ❑- FILTER BED WIDTH - -LENGTH - DEPTH DUSTANCETO.NEARE_CT: WELL - FOUNDATION- - PROPERTY LINE <br /> - - <br /> com <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: _ WELL FOUNDATION. PROPERTY LINE <br /> ❑ - SUMPS - WIDTH LENGTH- - DEPTH _DISTANCETONEAnEST:- WELL - FOUNDATION PROPERTY LINE f <br /> ❑ DISPOSAL;PONDS WIDTH LENGTH- DEPTH DISI'ANCETONEAREST: WELL FOUNDATION PROPERTY LINE- l{4 <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH 'DI.WANCETONEARF-W: .WELL FOUNDATION. PROPERTY LINE ..:., I <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,'STATE LAWS F <br /> _. AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> <Nj�1M 24 HOUR ADVANCE.NOTICE REQUIRE€?FOR INSPECTIONS,-PLEASE CALL('209)46$-3423 � f <br /> SIGNED: � �r C JC/_�14 e TITLE: e52 DATE: l� <br /> 3 <br /> ....._.._. <br /> f-T"'�` I- In��-��_`�---�•i_� i F._..._�--j—_I.— ' _ Imo, _} -4.—r�—_..T_.__Iw--- i�� � --6___._y._-'_'_°,-----i--•--jy..._....._ 1 �-r' <br /> — <br /> } .. — -- - -- - <br /> ! <br /> EOVI <br /> - U�?` -- I k <br /> Jn&r - <br /> .. <br />