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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION I <br /> 704 E.WEBER AVE 3'"FLOOR,STO�KTON.CA 95202(209)46R-3420 <br /> SDa NON-REFUUNDABLE PER-MIT EXPIRES I YEAR <br /> FROM DATE ISSUED <br /> JOB ADDRESS a/• Z7 /x mom R-0-A6 APN In l--0 <br /> 116 <br /> PARCEL SIZE:-L7+74 QG <br /> CITY/ZIP ,LINDEN BUILDING PERMIT 0_- <br /> OWNER <br /> -OWNER NAME6 4 P FOPPIA Na ADDRESS <br /> CITY2IP /� ' I PHONE NLMBERR Q J <br /> CONTRACTOR _ION C N�SbAJ r-y ADDRESS R oo, a o x B"7-14- <br /> "7_(T <br /> CITY/LP � R L17C •+' PHONE NUMBERy Y I V <br /> _ GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION__ 1 <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> O NEW INSTALLATION Cl RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPA(R/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 /> ❑ PERC TEST(S) HOW MANY-_ APPLICATION# <br /> ❑ SEPTIC TANK TYP&MFG CAPACITY-------- N OF COMPARTMENTS <br /> ❑ GREASETRAP TYPF/MFG CAPACITY 9O COMPARTMENTS <br /> ,-, ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINESDISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE__ <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DIST-ETONEAR- WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH ..-CE TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIATANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DESTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <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 <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. , <br /> �INIMUM UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)46R-3423 I <br /> �y <br /> SIGNED: � ��� TITLE: !!w1M-e/Z DATE: <br /> - I <br /> --� <br /> . i <br /> _ I <br /> T,t <br /> -t-._.. <br /> I <br /> _. Ilk �t. �-- [_- ___ y. -_f <br /> &, Pi.ITr-- "cZ U10, <br /> _ <br /> -L-f-�- <br /> F /I <br /> _ 1 I <br /> DEPARTMENT USE ONLY r� �?f!J� <br /> APPLICATION ACCEPTED BY __ DATE' I d AREA L I EMPLOYEE ID4DISTRICTQY,LOCATION;f <br /> INSPECTEDBY: _ ______uA TF.:____ PERMITFINALD YESDATE: INSPECTOR: - <br /> � I <br /> fOMMENTS: - - <br /> PECODE SC INFO AMOUNT HECK 'n5H RECEIVED DATE PERMITACRVICE REQU ESTR INVOICE. SEPTIC IDS <br /> REM RT BY <br /> i4) iL S Z ���t 4 �i�a-/o� 2�b 7 oo�8as <br />