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L LIQUID WASTE PERMIT ��y��( <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEM'AL HEALTH DIVIS102el "F' R :NV p j E <br /> SOS&WEBER AV&.3P°FLOOR.STOCKTON,CA 95202 (209)468-3420 REQUESS-FE <br /> NONREFUNDABLE PERMIT EXP/RFS I YEAR FROM DATE ISSUED FCR AL_L_ <br /> .IOBADDREss !! '�� b //L-lT� =/ �.'4y45 INSPECTSON <br /> CITYZP YYILw✓ PARCEL SIZE/APN <br /> J _ <br /> OWNER NAME_ ^2: 1��i e., i. -� �F:"�ADDRFSS ZL'[ ; /rte/ C <br /> CITYZP PHONE �^ <br /> LCONTRAC XR� I ,^r f � ADDRESS <br /> CITY/ZIP,�G'1r5 "t% ��,J Y PHONE <br /> GEOGRAPHICALINFORMATION: COORMANTES: X Y_TOWNSHIP_RANGE_SEMON <br /> LPERC TEST/S)( )HOW MANY APPLICATION <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIWADDITION Td DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL r'❑\OTHER <br /> L NUMBEROFN <br /> IINGUNITS:_ NUMBER OF BEDROOMS:_ NUMBEROFEMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMPSOH_CHARACTERo WATER TA BLE DEPTH_ <br /> ❑SEPGCTANKRTREASETRAP TYPEYM FG CAPACITY NUMBER OF COMPARTMENTS <br /> M ❑PKG TREATMENT PLANT DISTANCETONEAREST: WELL_ FOUNDATION_ PROPERTY LINE C <br /> F ❑LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ` ❑LEACHING LINE NUMBER&LENGTH OFLINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION -ROPERTY LINE <br /> 1 <br /> ❑FILTER BED WIDTH LENGTH DEPTH _ <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LINE 1 <br /> ❑MOUNDED WIDTH LENGTH " DEPTH <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ` <br /> C3 SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 11 sumps WIDTH LENGTH DEPTH <br /> DISTANCETONEAREST: WELL -FOUNDATION-PROPERTY LINE <br /> L 13 DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCETONEHRFST; WELL -FOUNDATION-PROPERTY LINE <br /> - <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE W LTH BAN JOAQUIN COUNTY <br /> ORDIANCES,STA LA WS,AND RUL LATIONB OF SAN JOAQUIN COUNTY. ` <br /> SIGNED: � A/' <br /> Ie TTILE.y DATE: <br /> L <br /> INA, 1 <br /> I <br /> '•� DEPARTMENT USEONLV ,[ <br /> APPLICATIDNACCEPTEOBY'. DATE: LA_N_%- <br /> TAN . SUMP INSHSCMD BY: I DATE <br /> FlNwLIN4PECIlON Bysej <br /> CCIMMENIS: I C7 <br /> PECODE 9C AMDDNT C RECEIVED BY DATE PERMRSERVICE REQDP9TY SEPTIC B]Y <br /> )NFD BEMIRE _A <br />