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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUALIC IfFALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> '"'} ,r 104 E.WL13LR AVC 3""FLOOR.STOCKTON,CA 95202(209)4W3420 / �! <br /> JOft ADDRESS_ ����/ t! /`•'ICU VON•REFI! ASLF PFRMtT EYPIRta 1 YEAR FR(1M DATE.ISSUED f5 <br /> —L APN X83 "/ PARCEL SIZE:AC <br /> C:1TYIZIPb� Q C7 <br /> RC'ILDIvC;PERMIT'A� <br /> OWNER NAME r� �a �-] �r�� ADDRESS <br /> CITl'17JP i _ _ PHONE NITIBFR _ <br /> CONTRAC.TOR-i-,AA,a�x--hi�yx .. t <br /> :\DDRFSS -_-� <br /> CITY/ZIP PIIONE NIIMBER_ 3 7Z30 <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X _ _v - _ TOWNSHIP RANGE: SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: _ <br /> k99-EW INSTALLATION ❑ RF.SIOENCE NUMBER OF BEDROOMS: <br /> ❑ RLPAIR/ADDITION �jY�COMMERCIAL <br /> /'-' NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER L L <br /> ❑ ENUINEEREWAINF,RNATIVE ��0�•7- <br /> CHARACTEROFS(HLTODEPTH OF3•• - -e PITISUNIPSOILCHARACTER-0/4' — WATER TABLEDEPTH: <br /> O PERCTEST IS► HOW MANY <br /> //�� APPLICATION'i 'L (off- <br /> `ld -SEPTIC TANK TYP6?MFG`c'LG. + CAPACITY? gU -Z7'*/#OF COMPART1v1E•N"I'S <br /> /❑ GRkASETRAP TYPG'MFG _.... _ CAPACITY NOfCOMPARTMF.NTS <br /> ❑ '14 <br /> i PKGTX PLANT DISTANCE TO NEAREST��w^^[LL/Or'f FULMDATIon/0,0 rr P,,m��OP��F R"IV LINE c--> <br /> LIFT STATION SIZE 7b �-�tPI Pi~t11RP ��� ND ARl1 R9ftIFIC�►USEDSYSTEA11 <br /> LFAC.H LINE. #OF LINES: LENGTI101;LINES: DICTANCFmvEARRr: WELL/C>0 /"'-FOUNDATION /d© /'-pROPMtTYLIN9l'Z�) ` <br /> INF'LITRATOR CHAMBERS: ' <br /> l <br /> ❑ FILTER BED WIDTH LENUCH DEPTH utAIANCY.'t'oNEARY%i: 1A.1-1.1- FOUNDATION PROPERTY LME <br /> ❑ MOUNDED WIDTH _ I.ENOTII DFPiH DIWANCE'10MANYXI: \\'lil.l. FOUNDATION- PROPERTY LINE , <br /> ❑ SI;MPS WIDTH LENGTH DEPTH DISTANrlTONFARF.ST: WELL_ _ FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WID'IH LEN'CTH_ DFPTH DISTANCE TONF.ARER: WELL _ FOUNDATION PROPCRTYLINF. <br /> �l SEEPAGE YI'I'S 'fURAMBI'PJI9 of DIVTAVC'E TU hEAREST: {l'EL[-? FOIIti I)A'ilUnPROPCRTI'LINE <br /> 1 HFRERY CFRTIFYTHAT I HAVE PREPARED THIS APPLICATION AND TIIE WORK WILL OF,DONE IN ACCORDAY(F WITH SAN JOAQUIN COUNTN'ORDINANCES.STATE LAW'S <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUN I%'. <br /> 311. Ml!Y1 24UR ADV'AN(:E?NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 11 <br /> SIGNED: _TITLE,: DATE: (c17-1 <br /> - <br /> I <br /> I <br /> I <br /> I <br /> } <br /> 1 <br /> t <br /> , <br /> ' <br /> �o' I <br /> al _ --I'- S1AN JOAOl1MtC <br /> -- i-- 3 -- - — —t----s 1 -I j--- FBf1C HEALTH <br /> HE L <br /> DF.PARTMF,NT LSE ONLY IIQ <br /> APPLICATION ACCEPT D i— DATE: i ARE,\ 1 1 EMPLOYEE MA 5%LDISTRicr L C TION <br /> INSPECTED BY: _ DATE: ft". PERMIT FINAL y YES DATE: TNSPCCIi)R: <br /> ({S {{ Y J !� <br /> COMME!` S A{1� �e �U�l -WJ .�I� �� I(J`ZZ•C �� L.I'VCf ♦�1 �/�IS Ap <br /> �S J<_c. P.x Pow 0,6ft A 77111NK X10 b trC�� I_-5 k Kfr� rS�a.4sto <br /> PE CODE SI:INFO AMOLN1 ICi".K+.'' SII RECEIVED DAII. ERFVt.F51SLI'IILIDN <br /> - �017o C3 X69 <br /> Revrseo 941"1 -- " — -- -- <br />