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r-- <br /> 4; I APPLICATION FOR LIQUID WASTE PERMIT 1�V <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ., V <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.00i.381.44".SAN JOAQUIN ST,STOCKTON,CA 95201.0306 COPY. <br /> st " F+t-4 (209)468.3420 <br /> ON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUE <br /> (Camplsts M Triplicate) �1 <br /> A ice n Is he eby made to the San Joaqui ounty for a permit to construct and/or install the work described. This application <br /> is _ n compos a with San Josquin County Deve e a ter 9-1110.3 and the Standards of San Joaquin County Publto Health <br /> Services, Envir tat Health Division. �t � <br /> Job Address/or ppAPNY�� �� E` 8 .e �" Q ri p4S Clty.L(A!D" Lot Slze�Y <br /> Owner's Name F-C'OCJ-t I r f C(ilclJ 1 Address D V �• Nf 1{W 2- UND" 967--3(- hone �Z <br /> .I Contractor'-51%W190 EJ��II� -P�iIJEl Address y045 COQFiiI -DD A E Lic/ Phone943"24&1 <br /> Sub Contractor Address 'Lic# Pho <br /> TYPE OF SEPTIC WORK: rNEW INSTALLATION I i REPAIRIADOITION I I DESTRUCTION I I PERC TESTI.)ip'Ilaw .NY <br /> Land <br /> SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) .NY _35 <br /> Land Use AppikaOan I <br /> Installation will serve: Residence_ Commercial_ Other_ <br /> Murbor of living unites Number of badroomar —w __� ►�+ <br /> Character---- Depth C'C <br /> SEPTIC TAI - - 1.01. Cgrpsrtmanb <br /> i <br /> PKG TREAT ge_gaalt2ir operty Lira <br /> �,••un 1/1 DIe onzazsT <br /> LEACHING 1r <br /> operey Lirr.� <br /> FILTER BED rnYTotr+E , P $t' T�� roperty Line_�pl' <br /> ORDER OF <br /> MOUNDED 3 O L L A'R S roperty Line <br /> SEEPAGE PI foperty Line <br /> SUMPS FA RS& �operty Line_ <br /> N>• MERCHANTS <br /> DISPOSAL P In BANK E�9fodA.k•e„ roperty LJne <br /> ' M <br /> 1 hereby c itn County Ordina e , <br /> and State; MEh10 �tlfies the folio BI <br /> "1 cerci _�...,w;-- i in such a name as <br /> to become; _ - - - --- - - __ ,.•mture certifies the, <br /> following: - - - � '�' +" cn rnts permit Is issued, I shall employ persons subject to work <br /> m <br /> AOVZ <br /> compensation laws of California." �I <br /> The applksnt must li,24 hours In advance ler all rqulre/Mep.etbu. Complete drawing below. /� <br /> Signed K t Title: `Y�T Date: f9 7, 11� <br /> PLOT PLAN (Draw to Scale) Scale " to <br /> 1. Names of streets or roads nearest to or bounding the property. 4. Location of house sewage disposal system or <br /> Z. Outline of the property, with dimensions and Worth direction. proposed expansion of sewage disposal systems. <br /> 3. Dimensioned outlines and location of all existing and proposed 5. Location of wells within radius of 150 ft. on <br /> structures, Including covered areas such as patios, driveways, the property or adjoining property, f <br /> and walks. I <br /> SOA MUA <br /> / O r 2i <br /> -_ ✓6 V I <br /> 5 e u�4.,nrMt�q( Y - (asst c <br /> I =i <br /> :I <br /> g P <br /> -="r"1I� - -'-•CCe. .c����.1'M_i.�y =L':PDO-f.��__ /. - _ I,-I-'• <br /> FOR DEPARTMENT USE ONLY -7 <br /> Application Accepted by _ Date: (.� 't-1 Area: <br /> V <br /> Tank, Pit or Surp inspee�c--••tion((��by Date '/ / Fri^nai I <br /> Jnspection by _�_py_ Date <br /> Additional <br /> Additional Comments' 2,Od lAr D &,-To- —, •4 """"''•'"""'O' "—"'- - -•� ( <br /> • Ce m e <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODE FEE INFO AMOUNT REMITTED AIRKGIASH RECEIVED BY URTE SRI PERMIT NUMBER INVOICE/ <br /> 222 7 g 77 y7 I <br /> Le <br /> e <br /> ih sat o st4.c Pte—d Pr off. <br /> -Er'"c vYv roc c.�il Gn si�? Gam% � . b.a��,t;,p <br />