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LIQUID WASTE PERMIT <br /> F SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304E.WEBER AVE-3"°FLOOR,STOCKTON.CA 95202 (209)469-3420 _ <br /> NON-REFUNDABLE PERMIT EXPIRU I YEAR FROM DAV,ISSUED (j <br /> JOB ADDRESS L - <br /> CITYl71P 1 � PARCEL S)ZFIAPN <br /> OWNERNAM ! C't ADDRESS <br /> CITY/ZIP ON <br /> CONTRACTO C ! - ADDRESS�I��� <br /> + PHONE <br /> CITYrLIP u <br /> GEOGRAPHICAL INFORMATION:COORWANTES: X Y TOWNSHIP—RANOE-----SECTION <br /> PERCTEST(S)( )HOWMANY APPLICATION#: <br /> TYPE OFSEPTIC WORK: ?/NEW INSTALLATION ❑ REPAHUADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ya-t[ESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNSTS:� NUMBER OF EDROOMS-_,l NUMBER OF EMPLOYEES:— <br /> CHARACTER OF SOILTO A DEPTH OF 3 FEET: i PJTlSUMP SOIL CHARACTER: C-&—,e WATER TABLE DEPTH) � <br /> EPTIC TANKIGREASE TRAP TYPFJMFG /1 "/ CAPACITY '��NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINF`, <br /> 0 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �/J S <br /> LEACHING LINE NUMBER do LENGTH OF LINESF 1rr lG._ INFlLIRATOR CHAMBERS <br /> DISTANCETO NEAREST: WELL FOUNDATION��-' PROPERTYLINEI <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST:WELL FOUNDATIONr PROPERTYLINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> ',DISTANCETO NEAREST: WELL pp__-FOUNDATION PROPERTY LINE <br /> EEPAGE PITS WIDTH LENGTH DEPTHIK <br /> S�,� i <br /> T DISTANCETONEAREST: WELL ejb2-4 FOUNDATION a0r PROPERTY <br /> I ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> — <br /> JI IHEREBYCERTI AT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCM LAWS,AND R AN REGULATIONSOFSANJOAQUINCOUNTY. <br /> SIGNED,'_ TITLE: J DATE:-F 1 <br /> P <br /> I" <br /> F � ONLY �/�(/� <br /> GATE: VJ ` W o I <br /> APFUCATION ACCEPTEDRY- <br /> DATE' <br /> TANILPIT.OUMPINSP CTE Y: Q <br /> FINALINSI R STON BY: <br /> COMMENTS: Lb <br /> PECODESC AMOUNT CRECK# RELEJVED BY DATE PERMR/SERVICE REQUEST 0 SEPTIC IDI <br /> rib" <br /> INFO Rem <br /> IT I I(Co lbo SSS �LOCJy2CP S d <br /> a <br /> i <br />