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LIQUID WASTE PERMIT <br /> ion 0 SAN JOAQUINCOUNTY <br /> EO WEBER AaVEI3 HEALTHFLOOR.STOCKTONN,CA 9 203 109)dµE3 ZTOH DIVISION <br /> 1 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATES ISSUED (x� <br /> JOBADDRESS IItOZd Fes/ woerAmj K%IE APN��? :F �/ PARCELSIZE:_`�� <br /> CITY/ZIP trrlC.KTON BUILDING PERMIT 6Z20L4-70 <br /> OWNERNAME rrUWYI L.K:Cwel'l1 ADDRESS <br /> CITY/ZIP PHONE NUMBER �JLrL y�CONTRACTOR IALD SHOAT INC. ADDRESS �GSO2�E� PM�A[�C RD <br /> CITY/ZIP L-06A "IJJJy� PHONE NUMBER .:110��11J1Z- <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:J_ <br /> M NEW INSTALLATION Y 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': CLAY PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> lbm ❑ PERC TEST(S) HOW MANY APPLICATION p ' <br /> I0SEPTICTANK TYPEIMFG C W-RGM VtL CAPACITY jjA6 j01LL0N #OFCOMPARTMENTS L <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> him ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> / / <br /> Iia LEACH LINE #OF LINES:_�LENGTH OF LINES:�D DtcfAnC[TOnGRLST: WELL�0� FOUNDATION 10' PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH OISTANC[TON[A—T: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIPTANCETONEAREFT: WELL_ FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DI.STANCRTON—M: WELL FOUNDATION PROPERTY LINE <br /> un ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH_ DLSTANCR TO NRAR— WELL FOUNDATION PROPERTY LINE <br /> ® SEEPAGE PITS # 3 DIAMETER DEPTH DIATANC[TONEAR6R: WELL 15a FOUNDATION 2/ PROPERTY LINE IO r <br /> 1 HEREBY CERTIFY THAT I 1/AVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS 1 <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IIIIIIIII MINIMUM24 HOURADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3123 <br /> SIGI D: A� TITLE: C'�'MQ�-R�TTbYC_- DATE:OS fb IQlQZ <br /> 4. <br /> p <br /> I <br /> PU IC EAI H': <br /> DEPARTMENT J E NLY `ff��'J!!�/ <br /> APPLICATION ACCEPTED BY: ,ACTT (�(� O AREA EMPLOYEE IDY'„I/�(�[DISTRICT LOCATION (7, <br /> INSPF.CTEDBY: DATE: x '✓'� PERMIT FINAL YES,,DAlE:II / INSPE/CTOR: <br /> !� <br /> COMMENTS 14 4 lrt� <br /> r <br /> PECODE SC INFO I AMOUNT ECKR H RECEIVED DA E PERMR/SER VICE REOUESTY INVOICEa SEPTIC IDx <br /> REMITTED BY <br /> q2-l[ I I 37.0 L-B-54 15,+�4aZ S&,0 Z <br /> r REVMEDxd Wl <br />