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LIQUID WASTE PERY"T <br /> N JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONN,�� ��L HEALTH DIVISION SEPTt/�� <br /> 3D4 E.WEBER AVE 3""FLOOR,STOCKTON,CA 9520 )461L34201420 7 - <br /> NON-REFUNDABLE PERMIT EXPIRES I YEA ROM DATE�/I),SSUED <br /> JOB ADDRESS / •fr APN O� ���V�O ` PARCELSIZE: <br /> CITY/ZIP ��•y�/e /��" <br /> CITY/ZIP 'T' BUILDINGAERMITp <br /> OWNER NAME A // 1 - � CTK� ADDRESS <br /> �( 4-G� PHONE NUMBER ��� / / �` " "• � /(� <br /> � - <br /> CONTRACTOR `��� ADDRESS <br /> CITY/ZIP 7 / �G�I / �Z' PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y. TOWNSHIP RANGE SECTION <br /> �zEJai <br /> OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> (❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER ,i(t3Ly <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3•: -wP /S MP SOIL CHARACTER: WATER TABLE DEPTH: �2 <br /> ❑ PEPERC TEST(S) HOW MANY APPLICATION# n,F J/o <br /> @� SEPTIC TANK TYPE/MFG �Ir CAPACITY .Ld&N�p/� #OF COMPARTMENTS •� G!/,/J� <br /> ❑ GREASE TRAPTYPEIMFG CAPACITY #OFCOMPARTMENTS__ <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) - <br /> Cl LEACH LINE #OF LINES: LENGTH OF LINES:_ DIWANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DPTANCETONEAREST: WELL FOUNDATION PROPERTY LINE . <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DLRANCe ionEAaENT: WELL FOUNDATION RETY LINE <br /> �IV1 \ <br /> i <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH_ DISTAFCETONEARESP: WELL FOUNDATION V <br /> ❑ SEEPAGE PITS # DIAMETER_ DEPTH DENTANCETOHEAREW: WELL_ FOUNDATION ^�S7 PROPERTY LINE C <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN CO,R.1�R O"RDINANCE ,11 A E LAWS <br /> AND RULES AND REGULATIONSOF SAN JOAQUIN COUNTY. PUBLIC <br /> HEJOAQUIN COUNTY C <br /> FIS BP(�1n8�Ln,5IJ�EALTH SERVICES [ <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209) 71•J'sH°TAI HE41 TH OIVISIm. <br /> SIGNED: <br /> TITLE: DATE: <br /> 7. <br /> L. r ru s- 4 I b. w <br /> �:... <br /> E..... DAY CHOO a \_ <br /> .............. <br /> 6.480 SgFL °yrT <br /> r- e2) 060 <br /> + �-IocDINb7eVIK#� l <br /> IRAP <br /> I_. <br /> I I <br /> n YAF2xTy3�h.1l�� --o44f , 4AP <br /> . •. . �� 22 r� AFyrox w' �-ncvr✓FsaRJ".IStE. ' V r- <br /> - .34"Acumi; IlA= Td <br /> DEPARTMENT USE <br /> USSE ONLY <br /> APPLICATION ACCEPTED BY: &40T <br /> DATE://I/ _ ,/ <br /> AREA EMPLOYEEIDN 166/ DISTRIQ'q LOCATION_ <br /> INSPECTEDBY: DATv- jz L/' �PERMIT FINAL'a'�YESDAT /��INSPECTOR: <br /> COMMENT <br /> .d <br /> i <br /> DECODE SCINFO AMOUNT C ECK ASH , RECEIVED I DATE PERMIT/SERVICE EGUEST# INVOICE. SEPTIC IDM <br /> REMI ED Y <br /> X10. D 7�5 <br /> REVISED LLIS-0I <br />