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LIQUID WASTE PERMS <br /> + JAQUSN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEh IEALTH DIVISION <br /> ' ��-.��� �• �� �'� � 304 F.WEBER AVE 7""FLOOR,STOCKTON,CA 95202(20�-.,68-3420 <br /> IL- 1 NON-REFUNDABLE PERMIT EXPIRES 1 YEAIRFROM <br /> /DATE <br /> JISSUED <br /> JOBADDRESS APN �Q J70 ��'-'1SUPARCEL SIZE: <br /> CITYIZIP BUILDING PERMIT# <br /> OWNERNAME + i JaL1 rJI ✓L7' S _ ADDRESS L�V Cb► C <br /> CITU/ZIP q -� Y 1 Lt �� 1 !Ic PHONE NUMBER 6 J 3 Q f 0 7 <br /> CONTRACTOR ADDRESS <br /> CITY/ZIP PHONE NUMBER <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 /> C] REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> DESTRUCTION ❑ OTHER <br /> E Q ENGINEEREDIALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH, <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> ❑ "SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS O l <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE Ni A <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 /> j INFLITRATOR CHAMBERS: <br /> E ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH D[STANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> 0 SUMPS WIDTH LENGTH DEPTH DISTANCETONEARRST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPACE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <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 /> IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—'!PtWE CALL(201))4.68-3423 <br /> 'XSIGNEDD: TITLE: _ DATE-k-l�— <br /> I � <br /> € i t <br /> ..... <br /> I <br /> (��n <br /> i G� e_, <br /> t � .. _..-_ 0 <br /> . f � <br /> .. <br /> E11f Ll{ l!AI_p t 13yl ,FS <br /> F <br /> ..,.... , f IP:-�,�M <br /> s ., <br /> - I. -. t <br /> � . U <br /> - - . <br /> - . _. i .-... .. r...... <br /> i - <br /> • <br /> i _-.i._ ..v....., , .. a IIx►. <br /> ....i.. <br /> -.-.....f .... .. -- ..,�,..,.., ..,..,. ---;- E I - ..,...., - ... .....- <br /> _.. <br /> r <br /> b.-. .i.. <br /> g.- <br /> I <br /> € � I <br /> .....- --_ .......fi ._ _ .. .. I <br /> i <br /> I : <br /> DEPARTMENT USF ONLY <br /> APPLICATION ACCEPT 1': DATE: 11' 7P,> AREA CqEMPLOYEE[Dk 3 DISTRICT LOC N - <br /> INSPECTED 8Y: DATE: �-4=� PERMIT FINAL❑ YES DATE, —N --s INSPECTOR: C <br /> COMMENTS: - <br /> PE CODE SC INFO I AMOUNT CHECK# ASH RECEIVED DATE PERMITISERVICE REQUEST# INVOICE4 SEPTIC IDx <br /> REMITTED RY <br /> 015 ��.LI �� 5� 3 5 <br /> RevlsEox-Is-al ' <br /> I <br />