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L1QUlD WASTE PERM—j <br /> 4 JAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEN iEALTH DIVISION <br /> 304 E.WEBER AVE 3"FLOOR,STOCKTON.CA 95202(209T469-3420 <br /> NDN-RF;F fNpABI.E PERMIT EXPIRES 1 Y'F;AR FROM DATE ISSUED <br /> o <br /> JOB ADDRESS <br /> (L,) D <br /> r r / _ APN 0 C� 1p i/ PARCEL SIZE: [�2.0 <br /> CITY/ZIP F7� <br /> pp ,QQ A BUILDING PERMIT 9 <br /> OWNER NAM£ i�/'� f"JjL,11 !� /" f' �^ ADDRESS V ��r' T <br /> Ci'1'YIZIP (�32C PHONE NUMBER_....__ r '. p ' t�O - <br /> CONTRACTOR ✓ ���(� -5 ADDRESS l t CCJ6 <br /> C1TYlZIPPf��(Q { .� (,} j -- PHONE NUMBER / <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X y <br /> TOWNSHIP RANGE SECTION <br /> TYPE;OF SEPTIC WORK: I� INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION II RESIDENCE <br /> NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDtT]ON II ❑ COMMERCIAL <br /> ❑ DESTRUCTION Q OTHER NUMBER OF EMPLOYEES: <br /> i; <br /> ❑ ENGINEERED/ALTERNATIVE <br /> i <br /> CHARACTER OF SOIL TO DEPTH OF 3':_ ©ct��_ PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH; <br /> ❑ PERC TEST(S) FLOW MANY i! APPLICATION# <br /> 1 <br /> SEPTIC TANK TYPE/MFG CAPACITY -CSG' #OF COMPARTMENTS -- <br /> i <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO�NEAREST: WELL FOUNDATION '1-{-,7 PROPERTY LINE i <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACEI LINE #OF LINES; LENGTH OF LINES: <br /> ,._ o DISTANCE TO NEAREST: WELL /'— FOUNDATIONS PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> t <br /> ❑ FILTER BED WIDTH �� LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH II LENGTH DEPTH DISTANCE TONE,AREST: WELL FOUNDATION PROPERTY LINE ' <br /> II <br /> ❑ SUMPS WIDTH !II LENGTH DEPTH DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE - <br /> I� <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE.TO NEAREST; WELL FOUNDATION PROPERTY LINE <br /> 1 <br /> ❑ SEEPAGE PITS # II DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ill I: <br /> I EIEREBY CERTIFYTHAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND R_EGULATiONS OF SAN JOAQUIN COUNTY. <br /> MINII�J� 2 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CC LL(211 468-3423 j <br /> SIGNED: ����// TITLE: t <br /> DATE: <br /> li <br /> I <br /> : <br /> .. i <br /> I� <br /> ....___ ...... _ <br /> i <br /> hyo v <br /> II : &D <br /> . <br /> U - <br /> � . <br /> rlDrosr� _ <br /> I <br /> 1F <br /> ....... .. ..... Ii .. - <br /> : <br /> I <br /> .,......�i,....... .,.... ..... !I _ .. .. _. _. <br /> : <br /> a <br /> �E({CFIC�` I JJN <br /> . .. r <br /> L NQIi�L.h'l�L <br /> t <br /> I , <br /> I, <br /> � t <br /> DEPARTMENNT/iLISI; <br /> APPLICATION ACCEPTED BY: -= I _DATE: / / " �.AREA G.. EMPLOYEE ID# C 1STR1C7 LOCATION-�� <br /> INSPECTED 8Y': _ DAT O-O PERMIT FINA6kf Y£S DATE: INSPECTOR: <br /> i` 7�� <br /> COMMENTS' .II <br /> l� <br /> PE CODE SC INFO ANIOUNT -HECKp SH RECEIVED DATE PERMIT/SERVICE REQUEST4 INVOICE# SEPTIC IDM <br /> REMITTED ,I BY - <br /> i. <br /> REVVED 8-I5-Or yy <br /> .I <br />