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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUJ;UC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 306 E.wERER AVE 31'FLOOR,STOCKTON,CA 95102(209)46R3420 <br /> NON-IREPUNDABLE PERMITEKPIRES I YEAR FROM DATE ISSUED <br /> JOBALDRESS �p�1 ��)k..J kik �� APN CQ7'- Z 1 L/r 02 PARCEL SIZE: <br /> CITY2IP „' BUILDING PERMIT M -� <br /> OWNERNAME_ LP� ADDRESS <br /> CTTYlZIP J _ , PHONE Nt)MBER ___-A <br /> CONTRACTOR�i _ <br /> CITVIVP, .(�.GC y JS,� PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES:X V'-_ TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LI V I NC UNITS:_ <br /> ❑ NEWINSTALLATION #- RF-SIDENCF- NUMBER OF BEDROOMS: 3 <br /> $,REPAIRIADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYERS: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE Lrl <br /> CHARACTER OF SOIL TO DEPTH OF 31: ;'I!)-rT PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: J <br /> ❑ PERC TESTS) HOW MANY APPLICATION P <br /> SEPTIC TANK TYPE/MFG <,kt-j CAPACITY­ff_Qr� 60I'COMPARTMENTS, <br /> ❑ GREASE TRAP TYPE/MFG ._......._ CAPACITY -. NOFCOMPARTMENTS <br /> D <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL L FOUNDATION-_- ' PROPERTY Uh'E_16� -n <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Iyr <br /> 9y LEACH LINE AOFL[NES: I.FNGTI4OFLINES:�6 nlxi�yfETO NuaEST: WELL_L 7 FOUNDATION_ ) PROPERTY IJNF-�� <br /> INFLITRATOR CHAMBERS: LaT•J <br /> ❑ FILTER BED WIDTH LEN4TH DEPTH DMTANCETONEARLST: WELL FOUNDATION PROPERTY LINE. <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_-, DP•TANCLTONEARPmT: WELL FOUNOAT]ON PROPERTY LINE d <br /> ❑ SUMPS WIDTH LENGTH DEPTH olNTANCLTCN"20T: WELL FOUNDATION PROPERTY LINF• <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTTI DIICfANLNTONTAPRST: WEU. FOUNDATION PROPERTY LINE <br /> jy SEEPAGE PITS # DIAMCTER--Z-f DBPTH-�, DATwCZTONTIAW: WELL- Q�L FOUNDATION75" PROPERTY LINE•.-- <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS 3 <br /> AND RULES AND REGULATIONS OP SAN JOAQUIN COUNTY. O <br /> MINIMUM Z UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL(209)46W423 <br /> SIGNED: _TITLE: DATE:zz <br /> 1 <br /> T <br /> _r. <br /> , <br /> i �- T- -' <br /> 'j <br /> v— L I... <br /> 1-4 <br /> I <br /> , <br /> I <br /> , <br /> I r. <br /> I 1 ����.:.�;; -;-•-,- '- - - .�...1�{ :j.: -.i..-: _..;_ ' _ I---T <br /> �...�.._..-.._.t_. - -- - -—i^ <br /> i I! <br /> IT IL 6a��Q�UIT i� 'J <br /> ... ...., E h <br /> 1 1 <br /> /I[}/"J� DEPARTMENT US ONLY , 4 4 r( <br /> APPLICATION ACCEPTED B ✓�`__� ' DATE_-7_- -AREAS EMPLOYEE]DR /Q� DISTRICT LIOCATIONJQ <br /> INSPECTED BY._- __ ___-..__..____-__._____DATE_ ,_PENMIT FINAL�/YES DATE:-[,1-d�rUT1411111111: <br /> FEfJOE SCINFO AMOUNT CH / 5N NECEIVED OAIC ITr4ERVICE REQ INVOICEM SEPTIC IDe <br /> REMITTED BY <br /> Is 19t 0 ). <br /> NEV15E0 tl-li-P! <br />