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LIQUID WASTE PERMIT A <br /> SAN IOAQUINCOUNTY HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION , <br /> 304 WEBERR AVEAVE 3"FLOOR,STOCKTON,CA 9510313091[A!L3410 <br /> P �� STeT <br /> —REFUNDABLE PERMIT E%PIRLS I YEAR FROM DATE ISSUED <br /> JOB ADDRESSI b_ oo F• r[oP� I'ZU HV APN �(p( -- 3 [' <br /> Q pp PARCEL MZR: <br /> CITY2IP _ „�p'ON \ " BUILDING PERMIIIT## r2 ``[] , <br /> OWNERNAME T}�NF. WINE, 6T'jdVle ADDRESS FDaz(�1�� tC�1VJ 12V <br /> PHONE NUMBER -C/"1' 1 >�'{ � <br /> cDNTRAcrQa 11�A': 1 �rAJ 61N 6GIZP� IUf ADDRESS PJO�etf ry (�UYE.p >(L%/ <br /> CITVZP TSV l QS2 4 PHONE NUMBER Zo9 3 b9 - 0122 <br /> GEOGRAPHICAL INFORMATION:COORDINATES:% Y TOWNSHW_RANGE_SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ <br /> At NEWINSTALLATION ❑ RESIDENCE <br /> ❑ REPAIRJADDITIONla COMMERCIAL NUMBER OF BEDROOMS: <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF B': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOWMANY APPLICATIONS <br /> g SEPOCTANK TYPE/MFG RQ'•` - - 1L CAPACITYL' (I)iZOpOFCOMPARTMENTS 2 C-^ '- <br /> ❑ GREASETRAP TYPEIMFG CAPACITY #OFCOMPARTNI NTS <br /> ❑ PKGIX PLANT DISTANCETO NEAREST: WELL_ i0UN0ATON pROPERryLME <br /> LIFT STATION SIZE TYPEOp PUMP SAND OIL SEPARATOR(ENGLOBED SYSTEM) .n <br /> 1� LEACH LINE ROFLINES: E4 LENGTH OF LINES:ESO 11Q�^^__1 L 1 "1 <br /> ol#[MY.2TON4PctT: WELLy¢A�y FOUNDATION-440' PROPERTY LINE9500 <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDM_ LENGTH DEPTH o1pTAxCci4ncu[cc WELL_ FOUNDATION_ PROPERTY LINE_ <br /> 13MOUNDED WIDTH_ LENOM_ DEPTH_ ere[wNC[TONG¢NT: WELL_ FOUNDATION_ PROPERTY LINE_ �(— <br /> ❑ SUMP$ WIDTH__ LENOTH_ DEPTH_ o:aAM'[roxE.[Rctrt WELL_ FOUNDATION_ PROF.,LINE _ <br /> ❑ DISPOSAL PONDS WIDTH LENGTH_ DEPTH OLiT1NfETOry[.1ppP: WELL__ FOUNDATION— PROPERTY LINE N <br /> ❑ SEEPAGEPITS a OAMETER OEM_ o1R.w[¢TOxpREtt: WELL_ FOUNDATION_ PROPERTY LINE <br /> I HEREBY CE PY HAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS Y <br /> / AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1M M IH HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-P 8E/C�A/L�L(209),683133 <br /> SIGNED: TITLE: JIB I L DATE: " JZ <br /> i <br /> I <br /> I I 'NE i 0 <br /> it <br /> I I aPv <br /> _. M'R SPC m' 1.1-z <br /> DEPARTMENT USE ONLY L.f/ <br /> APPLICATION ACCEPTED BY OATV�7pEA, I(}EMPLOYEEIOP_932(/DISTRICF1LCCATION <br /> INSPECIEDBY: -A-40 a3 PERM17F]NALD YESDATE. INSPECTOR: <br /> COMMENFS'. <br /> PEEBDE SCIW'O I AMOUNT ORE N RECEIVED DATF. I[E 0.EOUE31 INVOICEX EEITH'IM <br /> R UTED BT <br /> 4Zl�s 2- 350 2 v !/o <br /> 2/ I ZS-0 13 Sv Isaeo a 37 I / <br /> 0.6V6LO X.141 <br />