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LIQUID WASTE PERfV'- <br /> �oV-' %wo,10AQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMF. 'iEALTH DIVISION <br /> ` J 304 E.WEBER AVE 1"'FLOOR.STOCKTON.CA 95202 f�OAR-1420 <br /> 1 / NON-REFUNDABLE.PERMITEXPIRES 1 YEAR FROM DATE(ISSUED <br /> JOB ADDRESS_25'QU rA,(- 57,Pte. 132 APN -27S` It"- IY I� PARCELS/Zr: 73 7A-, <br /> CITY/ZIP �NALrS •�3Y'/� BUILDING PERMIT M }� y+ <br /> OWNER NAME— . evf4 er�_. ADDRESS lo-,62- L7L�SC /+J 496 F <br /> CTTY/ZIPyepwA L-1/7+[_-_____-��L�r.7 __-.__ PHONE NUMBER _ <br /> %07D"Ro' <br /> CONTRACTOR 001 ''CII/7.L<Ai�I -_ ADDRESS P . a C/ rr,, a4 <br /> CITYIZIP L�7tLC�t�K PHONE NUMBER "o-14-c-,3 <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X Y­­---­.­. TOWNSHIP RANGC• SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION O RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION 13 COMMERCIAL <br /> NU ER OF EMPLOYEES: <br /> 13 DESTRUCTION O OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPPTTTH: <br /> PERC TESIF(Si HOW MANY + APPLICATION p__ _ <br /> ❑ SEPTIC TANK TYPEIMFG— CAPACITY N OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE'MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKCPX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE____._.___ TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE M OF LINES: LENGTH OF LINES: DESTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE L) <br /> INFLITRATOR CHAMBERS: C <br /> ❑ FILTER BED WIDTN LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LrNE t <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DI.STANCETONEARESTI WELL FOUNDATION_-_ PROPERTY LINE <br /> ( <br /> ❑ SUMPS WIDTH LENGTH DEP IH DISTANCE TO NEARER: WELL FOUNDATION PROPERTY LINE <br /> O DISPOSAL PONDS WIDTH__ LENGTH DEPTH__ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HA%F PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAW'S C <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 411, 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)469-3423 <br /> SIGNED: TITLE: 496kWe2 DATE: <br /> i <br /> /I <br /> - L . D,ESEG w <br /> �Mr ' I <br /> ter. <br /> _ <br /> III -� II .—� �( 1• <br /> _.. .___._ h- ♦ - --f...t ANbOriFRN..�N iN i <br /> I � �-- I I i 111Ilr.Hf 41 JIh"•II'( <br /> (,a$q��F �� DEPARTMENT USE ONLY 4 <br /> APPLICATION AC('EPTEU BY! "JaICZN+ _ A7F.: 4 AREA_ EMPLOYEEIDE YO DISTRICT LOCATION <br /> lil <br /> INSPECTED BY: c DATES V (� PERMIT FINAL YES DATE-. � a v INSPECTOR <br /> COMMENTS <br /> PE CODE SC INTO AMOUNT CNEC .ASH RECEIVED DATE PERMIT/SERVICE REVUESTA INVOICEA SEPTIC IDT <br /> REMI'rrEO DV <br /> zzl 511 - o S 00 30+19- <br />