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LIQUID WASTE PERMIT <br /> SAN KJAOU IN COUNTY I'UBL(C HLALTH SERVICES ENVIRONMENTAL HEALTH OIV TMON <br /> 3(A L.W'EDER AVE 3"FLOOR.STOCKTON,CA 952D2(2a9)46N-342O <br /> NON- F INDABLE PERMIT EXPIRES I YEAR FROM DJA�TJE�769.S1:F.D <br /> JOB AW)RE.S.S J /�y)� `�// ,-L/r� _, APN, /ryf PARCELS(7F-._27 <br /> ('ITYfZIP.,.._. •���`//-1�`��i `-J�5/I J�JLr✓7�L�Z BUILDING PERMIT1il__. Al, A/'J/' <br /> OWNER NAMk; !t-GF/[/ /t/` -✓`1'� -.J_ ADDRESS /�` � C/\••� •�•�- .`/�— <br /> CITYIZIP�J,s�(1_G.N1�-- <br /> CONTRACTOR ,. __.— ADDRESS <br /> CyTYZ,P _ PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X-___ _t..-___ _TOWNSHIP,- RANGE_ ,.SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEWINSTALLATION Q RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIWAODITION Q COMMERCIAL NURIBEROF£MPLOYEES: <br /> DESTRUCTION <br /> ❑ ENGINEERED.ALTF•RNATIVF. <br /> CHARACTER OF SOIL TO DEPTH OF 31: PIT/SUMP SOIL CHARACTER: _WATER TABLE DEPTH: <br /> ❑ PEKC TESTS) IIOW MANY _`_ APPLICATION N <br /> ❑ SF.PT(CTANK TYPE;MFG CAPACITY FOFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPFIMFG _ CAPACITY :u OFCOMPARTMETITS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL_ FOUNDATION PROPERTY LINE _ } <br /> ❑ LI FT STATION SIZE TYPF OF PUMP SAND OI L 5EPAKATOR(ENCLOSED SYSTEM) N <br /> ❑ LEACH LINE #OF LINFS: LENGTH OF LINES:_- DMAN'CE TO NSARzsr. WELL FOUNDATION PROPERTY UNE v <br /> INFLITRATORCHAMSERS: _ ,L^' <br /> ❑ FILTERBED WIDTH LENGTH DEPTH___ DYTTANCETONEARLW-' WELL FOUNDATION PROPERTY UNE l <br /> MOt Nnr.D WIT)lH LENGTH DEPTH__ DETANCETONEAAM; WEAL FOUNDATION PROPERTY LINE <br /> SUMPS WIDTH__ I.FVGI'N DEPTH oKTANCETONEAccsr: WEI.I. FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTII DEPTH DWTANU..TONEARER: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE P/TS P DIAMETER DEPTH 08'TANCETONE fml. WELL FOUNDATION PROPERTY LINE_V) <br /> I HEREBY CERTIFY"THAT I HAVE PREPARED THIS APPLICATION AND THL WORK WILL BF DONE.IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATF.LAWS <br /> AND RLLES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR IN'SPEC'TIONS-PLEASE CALL(209)468-3423 <br /> SIGNKD; - 7-� �1-.2it,L m,..� _,_�T[TLE• DATE:, `\ <br /> } _ <br /> 1 ...... - <br /> -- <br /> . F <br /> • I <br /> I vf r , <br /> I <br /> •T- <br /> 001, <br /> 3IIME <br /> �� I I i M1 <br /> DEPARTMENT VSFO y-,yV <br /> APPLICATION A('CF.DjED HY '`�-- ..__.DATE: b " '-MiEA Z.LOYEE IDA � If LA DI.S(RI. _ ._ ATION <br /> T/ 4 o L <br /> IVSPFI7EDBY:_ yid r,)}/�/ 1 DAIh:_ �•�� PERMIT FI/NALP YES DATE: �INSPECTOR. <br /> COMMENTS0:�5 <br /> d "___""1�+5 - ZW '/10� Alz -- — <br /> PE CODE SC INTO AMOLID CHECK+•'SH RECEIVED DA7F. PERMIT.JERVICE REOUESTA INVOICE. SEPTIC IDI: <br /> REMTI TLD RY <br /> Zz �•7� g ) . - �� . S cz�3 7Sl <br /> REVISED R.ISII <br />