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tike LIQUID WASTE PER"'IT ,# -z1 X33.Goo <br /> /AN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRON AL HEALTH DIVISION <br /> n„ c' ' 4-IN Ave 304 E.WEBER AVE 3""FLOOR,STOCKTON,CA 9520 09)468-3420 <br /> (P�,A' J �p (� , + ON- UNDABLF.PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> ' 1N(n-� AV�i. S1OKS� / � p, ,�APN 183-32O-.Z� PARCEL SIZE: I O•� <br /> 41 <br /> CITV/ZIP'6f�2 --p9,� �LI'/11-Ar-ol CA _I$?.ZFi BUILDING PERMITIII <br /> / <br /> OWNER NAMIE 1 O Dje V /C'JJCJ'K flpI,�MAeI ADDRESS r,C)C1 CJ• ICGI U IL�X <br /> CITV/ZIP ISI�,1(�/I�f'l iyh-/�� -L523 PHONE NUMBER <br /> e��7� r <br /> CONTRACTOR [ '\ Irl CJ[JLTQJ ) G• ADDRESS ZVL-`7QG• ��Q `��� <br /> CITY/ZIP �1�` _I�«•� PHONE NUMBER ��-1� �T D — 17546 <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 /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3•: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> I FERCTEST(S) HOW MANY ..J APPLICATION# (lent <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE v <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE III OF LINES: LENGTH OF LINES: DESTANCETONEAREST: WELL FOUNDATION PROPERTY LINE `- <br /> INFLITRATOR CHAMBERS: C <br /> ❑ FILTER BED WIDTH LENGTH DEPTH UWANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ UISTANCETONEARESS: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH UIFTANCETONEARENT: WELL FOUNDATION PROPERTY LINE r <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIRFANCETONEARM: WELL FOUNDATION PROPERTY LINE ! <br /> .3 <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH_ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> - <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M NIMU 2 R V CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE: 1": E'er Ir— DATE: <br /> 1j <br /> t--- <br /> IftaTlc Aec .n <ra; �r kN 4 kNDDYS <br /> }I c <br /> .DIF <br /> 1 VD _ <br /> "71/ k>s •mp . ". xo •'••® - - <br /> 'II 1 w <br /> II 111111 rr���114444 N <br /> Ov � 4 //y\\ <br /> 7Pu11� <br /> II .... <br /> EA H _ E., 1 f <br /> DEPARTMENT USE ON`LVJ,(� II B••.E. <br /> APPLICATION ACCEPTED BY: I4[J4C/ >DATE: L AREA �/ EMPLOYEE IOM •5y µ DIST LOCATION <br /> INSPECTED Y: DATE: y"LG PERWT FINAL YES DATE M C pINNSPECfOR: <br /> COMMENTS: /`` <br /> PE CODE SCI FO AMOUNT CHECKNI ASH RECEIVED DATE PERMIT/SERVICEREQUMTM INVOICE' SEPTIC IM <br /> REMMED BY <br /> 2Z2 5Z1 2b-1 qhZ&g A 00313 S <br /> RRVtSED FI.C41 <br />