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LID WASTE PERMIT <br /> T� SAN JOAQUIN COUNTYP HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 (209)468-3420 00S <br /> NON-REFUNDABLE PERMI P1RES 1 YEAR FROM TE ISS ED V <br /> JOB ADDRESS- <br /> 7-19 <br /> DDRESS <br /> CITY/LIP fit/` PARCELSIIZZF//A�PNQ I -- <br /> OWNER NAME ADDRESS <br /> CITYIZIP PHONE <br /> �` t✓/�/ C:J'Z v !/R'�-' ADDREca �C <br /> CONTRACTOR �( t ---- - <br /> CITY/LIP PHONEU X/�.LI� &12$e <br /> ` <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP----RANGE—SECTION <br /> R�1 PERC TEST(S)( )HOW MANY _ APPLICATION 8: <br /> TYPE OF SEPTIC WORK: 13 NEW INSTALLATION -e RQEPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: airSIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:— NUMBER OF BEDROOMS: 0 NUMBER OFEMMPLOYEES:_ <br /> ERO� / <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACT � <br /> " WATER TABLE DEPTHO/eei <br /> S <br /> PTIC TANK/GREASE TRAP TYPE/MF CAPACITY-/-&!Q-0 NUMBER OFCOMPARTMENTS <br /> �� �- <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL , FOUNDATION—!2 PROPERTY LINE- <br /> +� ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> CHING LINE NUMBER&LENGTH OF LINES C�2 -JINFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL td-0— FOUNDATION PROPERTY LINE,_ <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST:WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE__ <br /> S AGE PITS WIDTH LENGTH DEPTH Z�T <br /> DISTANCE TO NEAREST: WELL/Cl FOUNDATION PROPERTY LINE-,—J — <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE REST: WELL FOUNDATION PROPERTY LINE <br /> I HE Y CE THA 1 VE PREPARED APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORD ANCES,ST LAW D RUL REG LATIONS OF SAN JOAQUIN COUNTY. � <br /> SIGN TI DATE: A-9 l// <br /> 1 I I I I I A (v^'I <br /> lA <br /> r <br /> I <br /> Q L <br /> n <br /> r <br /> FOR DEPARTMENT USE ONLY �J <br /> -APPLICATION ACCEPTED BY: DATE <br /> V PJf,OR SUMP INSPECTED BY: DATE���/ <br /> Ir FINAL INSPECTION BY: _ - <br /> COMMENTS: <br /> - <br /> PECODE SC AMOUNT C RECEIVED BY DATE PEiRMMISERVICE REQUEST N SEPTICIDN <br /> INFO REMITTED CASH <br /> p l ' <br /> ZSIb� <br />