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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> O.s.1 AI!X 399, A49 N. SAN JOAQUIN ST., STOCKTON, CA 95201.0388 <br /> 20914863620 L,-c L.L <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED <br /> (Complete in Triplicate) <br /> J.FLICATIIN:S RE.^.ES1 MAD£TO THE SAN JOAQUIN COUNTY FOR A FRMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> JOAOI.EN CO'V' i2`5:_:?:dEFT 1"TLE.GNAWER 11 3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> .1011 ADDf,.=` n ZEE, <br /> OnJ=9-7�J/_�M�1�✓/-J�— -.l'i4^T,r->1�. crrv�i �, CA Lor s)lzE-- <br /> OWUCP'E,.. i:_(_1} ,�-. ((./+•E.-lLJa^ILLI-LG�DDRESGw PNONE �/� <br /> CON�R+•f'r,r e�Ia G —� ADDRESS 9s L..r�/�N G7l/ UCI`JT? PHONE4k3r� <br /> 3U5 fiR.!/5+_'. n Q— _ADDRESS UCd PHONE <br /> 7 <br /> TYPE GP sIn^.8'e NPN INSTALLATION ❑ REPAIR)ADDIT10N DESTRUCTION ❑ <br /> NO 'L:3L2 SENER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PFRC TESTI.)1 1 HOW MANY <br /> APgivWon 9 <br /> ,R9YA6A00q 11M,Ffw'EPES'DENCE% COMMERCIAL ❑ OTHER❑ <br /> NLPARER C- :14^.SIN;I.:: NUMBER OF BEDROO{MM�S//:,,,,,, �INUMBER OF EMKOYEFB: <br /> ^HAAAty:-.F O' SGIL MI A CFE^"'Ir S FEET: RTISUMP SON-CHARACTERS ay 1&aN0j WATER TABLE DEPTR <br /> CAPACITY NO.COMPARTMENTS <br /> PKO TR£',-,W;T^Cfl'Tti ^iSii.dCE TO NEAREST: WELL-- FOUNDATION FROPERTY UNE <br /> LIFT STATKa!- E!,. 'YPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 4FACWUG f:VE � Eri S1.=.NGTM OF UNES4,0 / DISTANCE TO NEAREST:WELL�LFOUNOATION !r-'S7 PPAPERfY UNE <br /> RLTHR W. .i��9+:L`i:i LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> _LENGTH �y/OEPTH DISTANCE TO NEAREST:WELL ,�F(�}UNDATION PROPERTY UNE <br /> x• .:. Pli',®"kUMREP�_DarANCE TO NEAREST:WELL FOONOATION /Pf10PERTY IJNE_�, O <br /> mili�__UEFT,, DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> GISFG6D:. +':. "nRT'i LENGTH. DEPTH mSTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> 'FPAR�M THIS AP.PLICATION AND THATTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> ,,.; .. --:U:i! HOM£OWNERORUCENSED AGENT'S SIGNATURE CERTIFIESTHEFOIJ.OWING:'ICERTIFYTHAT INTHEPF.RFOBMANCE OFTHEMWFORWHICH <br /> ,T EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAIn--0RNIA.' CONTRACTOR'S HIRING Oft <br /> THF FU:i.GWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALLEMPLOY PERSONS SUBJECT TO <br /> .. •- ,> :109N)A.' T APPLICANT MUGT CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. - <br /> cvil <br /> d ff <br /> OATE 44 <br /> -. <br /> O C L y <br /> t+c. TO OR�OLINDINT E _ 4.IL,O A 10 O`HOU4 m.AGE Deems 6YSTE�OR RWFOBED <br /> SIM S ONS kND NORT DIRE TI N. II 7((7--,^^,, N 10 OF SEWAGE DISPOSAL SYS EMS. I <br /> O GF AI I EXI 1 G D li�-u Efi IB.IL' ;[44 HELLS WITHIN RADIUS ONE HUINDRED FIFTY FT.ON <br /> ( <br /> (OSI Uf!IV TYS O T9RACOVIRI <br /> 4 � <br /> 4 <br /> 41 <br /> J <br /> PAYMENT � <br /> RECEIVED 7LIJ <br /> It <br /> APR 10 1995 <br /> SANJOAQUIN COUNiv <br /> i' PUBLIC HEALTH SERVICES <br />