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LIQUID WASTE PERMIT <br /> {� SAN 3OAQU IN COUNTY PUj3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 504 E.WEBER AVE III"FLOOR,STOCKTON,CA 952021209)4M.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS--.4 =f V(T f' ^;r APN /tc�f Q L-�� PARCEL 517E: I�t nI <br /> CTTYIZIP !! •�~/1,�F/�`� 11//� BUILDING PF.RMITN <br /> OWNER NAME <br /> CITYILIP -`I - PHONE NUMBER <br /> CONTRACTOR t 1.�•k.�l6J7 -j. ADDRESS �.S G I• 1..• li <br /> % ," PHONE NUMBER_ Z- , <br /> CITY/7.[P —_..-..-.........__ <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X_- v TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> P5 NEW IN TION 9 RESIDENCE NUMBER OF BEDROOMS: <br /> t IRRIADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: <br /> DESTRUCTION ❑ OTHER <br /> ❑ ENGINEEREDIALTERNATIVF. <br /> CHARACTER OF SOIL TO DEPTH OF 31:_ PITISUMP SOIL CHARACTER: -WATER TABLE DEPTH: <br /> ❑ PF.RCTEST(S), HOW MANY APPLICATION4 <br /> SEPTIC TANK TYPE/MFG C� ��11� CAPACITY 4 OF COMPARTMENTS 2- <br /> ❑ GREASETRAP TYPEIMFG CAPACITY 4OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL__ FOUNDATION PROPERTY LINE <br /> ❑ LIFE STATION SIZE TYPEOFPL-MP SAND OIL SEPARATOR(ENCLOSED SYSTEM) \ <br /> /GI LEACH LINE NOF LINES: LENGTH OF LINES: 01F'TM-CE TD N[ARL17: WELL FOUNDATION PROPERTY LINE <br /> INFUTRATOR CHAMBERS: <br /> pP PILTER BED � <br /> WIDTH � LENGTH DEPTH t O nNTANt[1'ONuwERi: WELL FOUNDATION PROPERTY LINE d <br /> !!!❑„" MOUNDED WIDTH LENGTH DEPTH DIFEANCLTONV.RES7: WELL FOLNDATION_......__ PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH -IxT W9 W,NPARFRT: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH INWANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS II DIAMETER DEPTH DIST.NCCTONEAREST: WELL FOUNDATION PROPERTY UNE <br /> 1 HEREBY CERTIFY T 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN C'OVNTV ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIDNS OF SAN JOAQUIN COUNTY. l T <br /> NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL12091461-3423 <br /> SIGNED: -TITLE• DATE:-yfyC� <br /> I i I i <br /> I -'- -' - �-; I I`-- -;L�J�✓��'P� —I I —�—� ._ice_,_. <br /> r -�---�-- --i•• -- - '- -' -- 1 �_ Imo_ `•� 7.• "r .-j Cj'^+''---'-- -- <br /> T <br /> : I <br /> — <br /> T t <br /> I <br /> 1 <br /> DF.PARTM ENT SLLE LV //TT)) <br /> APPLICATION ACCEEPPTT,E BY: 7 FZAREA• EMPLOYEE IDi,/ VDISTRICTLOCATION <br /> . III �7 �'Y INSPECTOR: • Z"—" <br /> INSPECTED BV:_ DA7E: PERMIT FlNAL YES DATE: <br /> iMENTS: ~ � 0 <br /> PE CODE SC INFO AMOUNT f.NEC H RECEIVED DATE -f5ERY1CF.RFRL•ESTd INYOIC7:M SEITICIM <br /> 1 REMITTED HY <br /> v() 2qq <br /> REVISED R•ISAI <br />