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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON.CA 95202(209)46R-3420 <br /> LNON-REFUN BI.E PERMIT EXPIRES 1 VEAR FROM DATE ISSUED/� <br /> JOBADDRESS 7+^' �Yf7T APN O S3 0?D ]0 LJ- PARCEL SIZE: - <br /> OTYf/JP_z-l-'JG)au- ,_ BUILDING PERMIT R Qo,,a 1,. < < </ 7 <br /> OWNER NAME �klP��QGI- �CJ��'�+ J ADDRESS Sr„v� - <br /> CITYZP PHONE NUMBER--__ <br /> CONTRACTOR �o ,� vT� ADDRESS l J _JTA IT LYt�I 7/� <br /> CH'YIZIP _-_ PHONE NUMBER / / / 7a/V <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X Y TOWNSHIP RANGE SECTION <br /> INSTALLATION WILT.SERVE: NUMBER OF LIVING UNITS: <br /> EW INSTALLATION 13RESIDENCE. NUMBER OF BEDROOMS:_ <br /> FOFSEP'nCWORK: <br /> EPAIR/ADDITION ❑ COMMERCIAL - <br /> NUMBER OF EMPLOYEES: <br /> _. ❑ DESTRUCTION -' �CfTHEROZSG�/�.`I -- <br /> ❑ E•NGINEERED(ALTERNATIVE / <br /> CHARACTER OF SOIL TO DEPTH OF 3': ITISUMP SOIL CHARACTER: WATER TABLE DF.PTH:�/ <br /> `❑ PERC TM(S) HOW MANY/�� � /�� � APPLICATION# <br /> J SEPTIC TANK TYPFIMFG( '7�+ CAPACI"IY L2�� #OFCOMPARTMENTS___-a <br /> !/❑ GREASETRAP TYPE/MFG CAPACITY #OF COMPARTMENTS (� <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL,�'f FOUNDATION PROPERTY LINE /OO / y- , <br /> ``�I <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) "�1 <br /> ^� <br /> LEACH WNE kOFLINES: LENGTH OF INFS: DLSTAnC[7oNtARLST: WELL�J FOUWATH)N PROPERTY UNE <br /> INFLITRATOR CHAMBERS: Lli�f � <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DRTAnCRTON[AR . WELL FOUNDATION PROPERTY LINE n <br /> ❑ MOUNDED WIDTH LENGTH DEPTH ftWrAYCF.TONGRPAI. WELL FOUNDATION PROPERTY UNE <br /> ❑ SUMPS WIDTH LENGTHDEPTH DISTANCE TO NRARCSD WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH- <br /> _ DEPTH ZSf u .' LL / _ <br /> 1 PROPERTY LINE <br /> SEEPAGE P[TS � DIAMETERy� DEPTH DaTAc[TonEARAT: WE00 F_NDA70N-z-sl-- <br /> PROPpvy LINE Qc _ P <br /> 1-HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RVLES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI ' M 'bc 1111v ICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)463-3423 <br /> SIGNED: TITLE: DATE: 57- <br /> A-1 <br /> ^d Z <br /> I I I -' -- I �- -- <br /> - <br /> I _-'-- L u- 77 <br /> - <br /> -- , — — -- } -- — L+- <br /> -17- <br /> DEPARTMENT SF.O I.Y <br /> APPLICATION ACCEPTE BY: ��DIIATE: d REAy,,IENPLO/YEE IDY' )� �LOCATION <br /> INSPECTED BY: DATE' !1A '_ PERMITFINAL{( YES DATE: <br /> -L— <br /> COMMENTS: <br /> COMMENTS: IF Il-2'-L'z IT! ISIr-NPA C-*D fro+. /4,5y2VIS?� /Z• <br /> 11-02..vL, AW <br /> PECOUE SC INFO AMOUNT CHECK A3H RECEIVED DATE PERMRISERWCEREO T. INVOICE. SEPTIC IDs <br /> REMITTED tlY <br /> 059-0 �'ss3 z,t �� �2oa.11q30 <br /> REVISED&I"I --- - <br />