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r� LIQUID WASTE PERN11T <br /> (�7 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENV)RONMENTAL HEALTH DIVISION <br /> 301 E.WEBER AVE 3101 FLOOR,STOCKTON•CA 9520212091469-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATEISSUED _ <br /> JOBADDRESS _ I It/pZ�- Fi. NOQ,rIAF1c� I�JE APN4a3 7 C/ PARCELSCLE:��� <br /> CITYTZIP t—:rr0 -�'TD*1 _ BUILDINGPERMFTN 62,004'70 <br /> OHTiER NAME T/.lCN Y� LT1.0 I}�� ADDRESS <br /> CITY/ZIp p PHONE NUMBER <br /> conTRAcroR nPdCrD i"SNORT SNC. _ ADDRESS Sb50 E6. MD '�E QD, <br /> CITYlUP�i "17TJ-EO PHONE NUMBERM!57- <br /> GEOGRAPHICAL INFORMATION: COORDINATLS:X _Y ,• _TOWNSHIP _RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:�— <br /> Y NEW INSTALLATION IN RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR'ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER <br /> NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED,ALTERNATIVF. <br /> CHARACTER OF SOIL TO DEPTH OF 3%CLAY PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY APPLICATION <br /> SEPTIC TANK 7YPERvIFG COAICRftj _P*L CAPACITY �'(�(1 gt�11,D11 40FCOMPARTMENTS Z <br /> LI GREASE TRAP TYPEIMFG CAPACITY�� #OFCOMPARTMENTS <br /> ❑ PKGTX PWM DISTANCE TO NEAREST: WEIJ. FOUNDATION PROPERTY LINE ' <br /> ❑ LIFTSTATION SIZE TYPEDFPLUP_ ,-_- - -_ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> � <br /> LEACH LINE #OF LINES-.--3--LENGTH OF LINES: L• DI DSTANCETONEARM-. WELL I 10A FOUNDATION IO PROPERTY uNE70 <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENOTH DEPTH DI5TANCETONFARE f: WELL FOUNDATION PROPERTY UNE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DLSTANCETONN LM WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEMI .L NCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> I ❑ DISPOSAL PONDS WIDTH EJSNDTH DEPTH DMANCLTONEAREW: WELT- FOUNDATION PROPERTY LINE <br /> S' -7 6 <br /> � <br /> SEEPAGE PITS —S DEPTH ZDIM7ETER D4TANctroNuaLs7: WELL1y O FOUNDA710N� PROPERTY UNE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OP SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)"11,3123 <br /> SIGNED: 4VW— DATE: <br /> a erata <br /> 1 I <br /> i <br /> .. I [ 1 <br /> - -i.. _.r.._.�..,.- ..........:_..._ _ <br /> 1 <br /> EE- <br /> fff • <br /> - _- - ii <br /> J t - <br /> -j•- <br /> - i <br /> 4-AAl'ym&Nlfroey�6�t��r_ > <br /> T- <br /> — <br /> - : <br /> . • __ _��—__—.t___.._-y__ <br /> —' <br /> 1 •—� 1- :PU IC Ea I I f—— <br /> 'r <br /> i i 1 <br /> . <br /> i i 1 <br /> DF.PARTMENNNT //E NLY �� <br /> APPLICATION ACCEP .D BY: A (C� AREA EMPLOYEE IDApISTRICT LOCATIQN <br /> IF <br /> INSPECTWB:� ,." _.-DATE' �,//'W" /PERMR��FIN�ALQ�.,YSS'D`AC� 4 �INSPECTOBI <br /> COMMENTS:,tT/C��/ LS N l l / Ely- <br /> PE CODE S<INFO AMOUNT ECK 0.ECEMM DATE 4 P—ERMITINERVICEREQDFST9 INVOICU SEPDC IN <br /> REMITTED DY <br /> Z l It % 2.. 34 <br /> REVISED�-15-0e <br />