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� / LIQUID WASTE PERMALTH DIVISIONte' l) <br /> SATMPAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENT <br /> 704 E.WEBER AVE 3R"FLOOR,STOCKTON.CA 95202(309)4AR-3420 <br /> /JC - NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESSS��Ly✓5817+ W. H W T q9 APN Oa J - V l© - J 3 PARCELSIZE: <br /> CITY/LP�iP{�I�T/r�✓'�2 4� BUILDING PERMIT p� `� Awa <br /> OWNERNA�RM�IET�T�n��AM�./GIC /��W�J ADDRESS_ 'WVL.�JEGJ I��D/EJT•R 1�VE. <br /> CITYlZIP IP oDal'b lam/ -.{"55355�J �J.�_ T PHONE NUMBER ✓I!'1"YpI�.JE� <br /> CONTRACTOR IPE LLUI�I PYLA ' SFIOF iNG. ADORESS 5�S2O, Q�.•MOE...b[� t! <br /> CITY/ZJP O PHONE NUMBER Jf0 1" /SSS 7 <br /> GEOGRAPHICAL INFORM C IN TES; X Y_ TOWNSHIP RANGE SECTION <br /> TYPE OF SEP K:\i7 INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: I <br /> ❑ NEW INS LLATI J;.J O RESIDENCE NUMBEROF BEDROOMS: <br /> REPAIR/AJ ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> El DESTRUCTION LIOTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST IS) HOW MANY APPLICATION <br /> Jif SEPTICTANK TYPE/MFG 6XI5'Mk CAPACITY L7A0 NOFCOMPARTMENTS Z <br /> ❑ GREASETRAP TYPE/MFG CAPACITY NOFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> T <br /> ® LEACH LINE NOF LINES:?L LENGTH OF LINES: 1�- OI OTATAf1[EiONGRLAT: WELL ICOt FOUNDATION Lid PROPERTY LINE IO <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH BEPTH MITAFCR TO NE.AREAT: WELL_ FOUNDATION PROPERTY LINE (� <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIATABCETON[ARERT: WELL_ FOUNDATION PROPERTY LINE v ' <br /> ❑ SUMPS WIDTH LENGTH DEPTH DMANCETONEARLST: WELL_ FOUNDATION PROPERTY UNE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH BIETANCETONEAREST: WELL FOUNDATION PROPERTY LINE 1 <br /> At 5f <br /> SEEPAGE PUS N :5DIIUIMETER�10r F DEPTH ZS' OCasnCE TO NEARER: WELL ISO+• FOUNDATION PROPERTY LINE IOD <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 `G <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ` <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PPLEEA��S,EACAALL(209)46X-3423 ,1 <br /> SIGNED: TITLE:_C&V- I PT aV f- _DATE: UT I5 <br /> F <br /> - - <br /> i <br /> _. �... <br /> ---- E -116 - - <br /> - fr _�_ - _�...... -. <br /> �- - - — <br /> - <br /> _- <br /> I- <br /> -T <br /> If <br /> < - - <br /> - -- -- - - <br /> --- - -- 1 <br /> i I <br /> _ 1 , I <br /> I , <br /> DEPARTMENT USEONLY <br /> APPLICATION ACCEP OB DATE: 1✓ AREA �'2 EMPLOYEE IM OAr DSTO LOCATION <br /> INSPE BY. DAT/� PERMIT FI AL V : �� -f <br /> N ES DATE. INSPE ZGt <br /> { �N 9 <br /> COMMENTS: Lo I Irn r, Q ka ow f <br /> PECODE SCINFO AMOUNT HECID' H RECEIVED DAtE PERMITSERVICE REQUESTD INVOICED SEPTIC IM <br /> REMDTED BV <br /> 4ziZ � ►S i8o ze�5 415 oL S�oo2� 9-5s <br /> REYIREO D•ISTI <br />