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SAN JOAQUIN COUNTY.PUBLIC HEALTH SERVA4QUID WASTE PERMIT <br /> ENVIRONMENTAL.HEALTH`OLVW0MI COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ��- <br /> 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 (209)468-3420 1 f <br /> SPECIAL PERMIT NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED n I '� �/ O 1 <br /> jpB ADDRESS ` /.. /.D �/. j�'/G'CiU�/ 1✓V. -- <br /> CITY/ZIP c7 �j�/� ^ r <br /> �+ PARCEL SIZE/APN <br /> OWNER NAME kAl!�/��� t��GL✓L S^/ A�dADD/RESS r_•0 �J/X `o��a <br /> CITYrLIP toe, //r 'G��'i'S" L�Y %UV 40'0 —PHONE (3'l�'�L,�} / / !V <br /> CONTRACTOR //�,I ��/'y e(/44_*y' i � plt�S !/r�1AARESS T a/7 leW y_&t4•L ���C•/ (�/NiTC9 <br /> CITYlLIP EJ/�C.li9/L!(a't/3�t7 � � /�_6`f PHONE (916 > R-7 J- 9-/,(-L- <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP-RANGE-SECTION <br /> PERC TEST(S) ( ) HOW MANY11��,, APPLICATION#: <br /> #9 <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ D UCT N <br /> INSTALLATION WILL SERVE: ❑RESIDENCE 9RCOMMERICIAL ❑ ER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYE <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WAT TABLE H <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> LIFT STATION SIZE /SW 60- TYPE OF PUMP��u'�SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES 6 / /Q7 INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL Nff FOUNDATION 570 DROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> SEEPAGE PITS WIDTH LENGTH DEPTH //''�/�����..��-- <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 1�%""�J v <br /> ❑SUNIPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE /J <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT '7 )UNTY <br /> ORDIA v CY�SnN6 ^srvRh DtAINAft PaN>• <br /> SIGNE <br /> I I , <br /> ` — — --- — — — — — — �IVE LSr°J VA LVES Wi/N Scf3vc5 TD GRAD[ <br /> I � .� r`••A/k C•�V.it ---le./..ill E�•Y.YC <br /> I 4 c+u-e.�rn NvHoff <br /> - <br /> 7 - <br /> I <br /> I <br /> C/ <br /> Z! <br /> ioo' loe' 3'6'Dray' 0 3'Ir bf'OAy w <br /> I; _ rlP,aec or 4 a <br /> IJ i <br /> �-- —loo• _ ...---Ip.•-. 7�c,",D�aL'..._...0 f-!'a't Mt=t� <br /> ZO O— -- -- r---- —zalnt- -- <br /> ° _•..._.._��__'3_�.n�.r__....0 DEC 2 9200UINn <br /> Y <br /> SAN <br /> PI <br /> PUBLI�HE l;�'I;k.5 <br /> o--- -- —�--- _ <br /> ENViRONMENIAt <br /> CN&S 9ndFj2Aoc Al_#u.11) kVe*f F16LD�' <br /> 1990 N' p,cc,Li > a. /� toa ne✓4c c,r.+' <br /> STOLIGNN i CA. T2f4tK•- L_-0,46I s AJel'i ✓ - �----- Ex,s.,�a c,res <br /> FOR DEPA Erv'C USG VrvLY <br /> APPLICATION ACCEPTED BY: AlfDATE: <br /> TANK,PIT.OR SUMP INSPECTED BY: q DATE* <br /> FINAL INSPECTION . 3 ~ <br /> COMMENTS: fWnwo k-)� <br /> PE CODE SC V AMOUNT CHECK#/ RECEIVED BY DATE PERMIT/SERVICE REQUEST# SEPTIC ID# <br /> INFO REMITTED CASH <br /> .2So ago ')w aR l;q a <br /> 1 <br /> s pI'I, <br />