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LIQUID WASTE PERM' <br /> IY� VOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONM�/IEALTH DIVISION <br /> �/ <br /> /}�" 301 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(297F469-3420 <br /> \ n •� NON-REFUNDABLE.PERMIT EXPIRES I VEAR FROM DATE(ISSUED <br /> JOBADDRESS ;?.549a �I �" F+ f3cZ APN -2 575 d-�' Y J� PARCEL SIZE:-�LftL <br /> CITY/ZIP VER1r A(-I S q530!5- BUILDING PERMIT#MI <br /> OWNERNAME b. Bof4er-r/ ADDRESS 1 -V • VO)C -149TJ <br /> CITV/ZIP VERNAL-t/ q 305 PHONE NUMBER /��( <br /> CONTRACTOR �D1Q Ole5AJJ)cy! ADDRESS P. to pox 37,q.+ <br /> CITV/ZIP )z Loc PHONE NUMBERRP((7 <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 /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> Ll DESTRUCTION El OTHER <br /> NU ER OF EMPLOYEES: <br /> LIENGINEERED/ALTERNATIVE � L g ) <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ld PERC TEST(S) HOW MANY ' APPLICATION# <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Cl LEACH LINE #OF LINES: LENGTH OF LINES: DLWANCETONEARKST: WELL FOUNDATION PROPERTY LINE V <br /> INFLITRATOR CHAMBERS: 1' <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DIBTANCETONEAREST: WELL FOUNDATION PROPERTY LINE 1l. <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ DISTANCETONEAREW; WELL FOUNDATION PROPERTY LINE <br /> .t <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREET: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER_ DEPTH DISTANCETONEAREW: WELL FOUNDATION PROPERTY LINE 4 <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS I <br /> 7 AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI { 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SJGSKD: TITLE: DATE: /2 Z6'-02 <br /> I �. 1 -- -- f ... t <br /> .... R _ <br /> t _ T r <br /> /3 <br /> .�,� -. f <br /> r <br /> 1 .... , I r i_� <br /> r + + �: 4 t t <br /> f. <br /> .....- ___�; i .-_}....-. -..L....-.. -4. ..__�._I . -4-..... ANI I A464 v 7 T u Ic r+ n �e'vic s <br /> '/, ,!y1 <br /> DEPARTMENT USE ONLY IIS,, Y A <br /> APPLICATION ACCEPTED BY: WS[`[ "4.N"K�f/�+ DATE: •AG 1/ AREAEMPLOYEE IDB V O DISTRICT LOCATION <br /> INSPECTED BY: Jll/A/l� \ DATE: V v PERMIT FINAL,/YES DATE: � a VINSPECTOR: <br /> COMMENTS'. ��.L�\L�'•_l IJlIL� 11 V)/W , L_7,• —_- _- <br /> PE CODE SC INFO AMOUNT CHEC ASH RECEIVED DATE PERMITSERVICE REQUESTN INVOICEN SEPTIC IM <br /> REMITTED BY <br /> 21Z 5Z� a — o S 0030+14- <br /> CK 6,1 —3JKe � <br /> REVISED&I."i <br />