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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 1 <br /> 304 E.WEBER AVE 3"'FLOOR STO�KTON,CA 95202(209)4AM-3420 <br /> /� <br /> / <br /> NON-REFUNDABLE PERMIT EXPIRES I/YEAR <br /> 'FROM DATE ISSUED <br /> JOB ADDRESS^,��4A!. T—Ar-9 <br /> TWE POA() APN /[J 1 -Dyh �-_ PARCELSIZE:1+AG <br /> CITY/ZIP kAlbe/J BUILDING PERMIT N <br /> 1 <br /> OWNER NAME 64 P FIOPPJA Na ADDRESS <br /> CITY/ZIP �)�+ PHONE NUMBEP.O. <br /> R� «gyp J <br /> CONTRACTOR DO,Nf CH�.SN ry ADDRESS Y.O• BOK B /-lT <br /> CITY/ZIP �d�L-[/L� L//� PHONE NUMBER �61 • 14& 3 <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 /> ❑ REPAIWADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> L3 DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: ' <br /> ❑ PERC TEST(S) HOW MANY Z APPLICATION# <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH b TANCEWNEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH OEATANCETO—RE-tt: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DKTANCETONEARPST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH - DICTANCETONEARCST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DLCTANCETOWARLW: WELL FOUNDATION PROPERTY LINE <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 /> fyQI,INIMUM UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)4"-3423 1 <br /> SIGNED: rrV/rI'� 4:�ye TITLE: C/wN � DATE: <br /> .01 <br /> I <br /> I - - <br /> - <br /> ' <br /> .P i - <br /> f— - 39 ulfcc Uff 7- <br /> - <br /> - - <br /> 1 - I VgnN.,.FNT: 4- <br /> I T <br /> ' i DI ISMO <br /> ' — <br /> I I <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BV: - DATE: I AREAS EMPLOYEE ID&�I—DISTRIR617—LOCATION <br /> INSPECTED BY: _ _DATE PERMIT FINAL O YES DATE: INSPECTOR: <br /> COMMENTS: <br /> DECODE SC INFO AMOUNT HECK 'ASH RECEIVED DATE PERMITISERVH'E REQUESTA INVOIC" SEPTK IDY <br /> REM{lT flY <br />