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LIQUID WASTE PERMITS SEPTIC <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION _ <br /> 304 E.WEBER AVE.,3R0 FLOOR,STOCKTON,CA 95202 (209)468-342(r <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7-/4-740 <br /> tl. g?owuas YDP AfdbMo <br /> CTTY/ZIP Q5z'7'p PARCEL SIZPJJAAPNDOIG <br /> ZcD:------ <br /> OWNER <br /> -OWNER NAMEyfto jil ADDRESS IRCOl OULS <br /> y-DfA\/C-` /� <br /> CITY2IP �IVL/C.-'I Cl1`' q LrmA A, � PHONE Ll/"1-�1/Igf--- 4900 <br /> CONTRACTOR 5��,n.1L/''IfLIGD /EKAIT�(- I D7 AlTV? 6 ADDRESS ''^^�Y�, -n MWi/N kDD MIr_ <br /> CITYIZIP SMCMDtA %zo g PHONE /�, qq s-,;20,.A 1 <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP�19RANGE-li5-FSECTION� <br /> PERC TESTIS) Of HOW MANY APPLICATION A: V6-01-ZZ <br /> TYPE OF SEPTIC WORK: ❑ NEWINSTALLATION ❑ REPAIRIADDITTON ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL IWOTHER -fp-L f/tIE Id1�P <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANKIGREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 13 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH cc11 ` <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE N <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 <br /> ❑SUMPS WIDTH LENGTH DEPTH / ^ <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE V ) <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCE�TS'T,ATE LA WSr AND RU.LI�S AND REGULATIONS OF SAN JOAQUIN COUNTY. iI <br /> SIGNED: lJL/ ��TYf//�Y TITLE: DATE:ul <br /> r�Rn�r <br /> T6.vtatlV6.VAP <br /> �.• �• r .awnr,:w w <br /> "7 <br /> - 9� -�5, � •. ww t� I�fµlllnr..r <br /> " Q <br /> S hr <br /> a B[j a <br /> I•RIli�caPglwn'" .. <br /> L.J. I II �1nI•`l i i I I I I I I i i i i i i i <br />