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LIQUID WASTE PERMIT 1� -Z1 X33. C�1 <br /> AveJOAQUIN COUNTY PU,I3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIV ISI <br /> I, 304 E.WEBER AVE 1"'FLOOR,STOCKTON,CA 95202 009)46K-3420 <br /> UG �1 tiON- ':UNDABLF.PERMIT EXPIRF-S 1 YEAR?I Rt)M DATE ISSUED <br /> JOB ADDRESS _ Ave. SC C�APN I 3-3 - ;-,I PARCEL SIZE: IO•-A?S <br /> CITY/ZIP `LI'l,Y_f}E'.E1 BUILDING PERMIT <br /> OWNER NAME ` '[�.�e�pma,•�n_ ADDRESS_-C�_ <br /> CITY/ZIP L�^wn / �-/'1 5�3`j _ PHONE NUMBF:H ^ A <br /> CONTRACTOR—_ 1✓ wr �{/�C-' _- ADDRESS- <br /> CITY/ZIP7Nj'JV�--� Zo-S PIIONf: NUMBER_ <br /> GEOGRAPHICAL INFORMATION: COORDINATES. X ---Y-- TOWNSHIP RANGE SEC"TION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNIT'S: <br /> /' NEW INSTALLATION /x RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEEREDiALTERNATIVF. <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> I PERC TEST(S) HOW MANY APPLICATION# 41011� <br /> ❑ SEPTIC TANK TYPE­/MFG_ CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITYCn <br /> #OF COMPARTMENTS C <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 LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELT._ FOUNDATION PROPERTY LINE <br /> .J <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> eb <br /> 1 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 /> NINIMU 2 111 V 'CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE: _ DATE: .7 oZ <br /> • II�jII <br /> .. RIE I D� <br /> - i I _'_.. .f _... ... - `I e •-�� r� o >�NT K Yf /s �t•k�` ..�N .vm4 <br /> a /fC <br /> I <br /> J/��j <br /> V <br /> 1 I •.� I' _ V <br /> _ .+.... .�..... �... ,0 <br /> ~ 4 V O .� E b <br /> y <br /> ^ °W\W n p <br /> L tT <br /> 1. <br /> 4 Yom—}— <br /> Igo <br /> /G74!I /67.19 <br /> hr <br /> •Yi i Y, u u 4 w i'Y v m <br /> __............ FLAff <br /> 1 <br /> I I <br /> PU UC E�,TN � L J� f --1-_. �-- -- � _. 1 � t-'- - � � -i -}---'—• - <br /> ° DEPARTMENT USE ONLY Zrft(- j� <br /> APPLICATION ACCEPTED BY. "�Jw - ___DATE:'AREA_ I' EMPLOYEE IDM _DIST 1�, LOCATION <br /> INSPECTED Y_ �� DATE: !��/G� PERMIT FINAL YES DATE- «' INSPECTOR=_"- <br /> r p ��••:+7 r � <br /> COMMENTS, /gQ. <br /> PE CODE SCINFO AMOUNT ASH RECEIVED DATE PERMIT/SF.RVICF.REQUEST# INVOICE# SEPTIC IDN <br /> REMITTED BY <br /> 2ZZ X21 ��� rl' f S t�Q 3 f 3 I+I <br /> RRVISED 11.1"1 <br />