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LIQUID WASTE PERMIT <br /> SAN JOAQUINCOUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304E•WEBER AVE„31O FLOOR,STOCKTON.CA 95202 (209)4-3420 _ <br /> NON REFUNDABLE PERMIT EXPIRES I TEAR FROM DATE 15SUF.n <br /> JOB ADDRESS FCC}Fi ♦t,.1- <br /> CITYm PARCELSEIAPN t <br /> OWNER NA]rlE� ( �L� —ADDRESS <br /> CITY/llP HON <br /> C ADDRESS <br /> CITYMP 4u& PHON <br /> GEOGRAPHICAL INFORMATION:COORDIANTIFS: X Y TOWNSHIP_RANGB---5FI=TJON--REVCIVE. <br /> PERCTTST(S)( )HOWMANY APPLICATIONR: R 13 2001 <br /> TYPEOFSEPTICWORK: OL NEWINSTALLATION Q REPAIRJADDTCJON CI DESTRUCTION <br /> OUNTY <br /> INSTALLATION WILL SERVE: 11�RIiSIDENCE OCOMMER[C1AL E3 OTHER S^—��H�THERYICE$ <br /> NUMBER OF LIVING UMTS: NUMBEROPBSDROOMS: NUMBER OF EMPLOYEES:—EWNNIENTAL HEALTH DMSIDN <br /> CHARACTER OFSOILTO A DEPTH OF 3 FEE.. 4 113" PITJSUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> E3 SEPTICTANKIORPASETRAP TYPE/MFG [ CAPACITYOD NUMBER OPCOMPARTMENU9 i' <br /> ❑PKG TREATMENT PLANT DISTANCE'TONEARFS7: WELLz(2-� FOUNDATION 27' PROPERTYLINE A: <br /> 13 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSIW) — <br /> U.LEACHINGJJNE NUMBER&LENrTHOPLDUS--I--J_ i!e INPILIVATORCHAMBERS <br /> ��L f i <br /> DISTA14CETO NEAREST: WELLJAK FOUNIATION...is' °ROPBRTYuKE 2a <br /> [3FILTER BED WIIYl'k] LENGTH DEPTH . <br /> DISTANCETO NEAREST:WELL FOUNDA7I0N'._,__^PROPERTYLINE <br /> O MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> f <br /> QSECPACE PITS WIDTH LENGTH DEPTH-- <br /> DiSTANCPTONFARF,ST- WELL FOUNDATION js _PROPERTY LINE•, <br /> OSUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 13DISPOSALPONDS WIDTH LENCTH DIEP-H <br /> DMANCBTONEAREST: WELL FOUNDATION PROPERTY LINE <br /> E I HEREBY CERTIFY THAT I TTA VE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> O"IANM,STATE LAWS,A140 RULES ND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> SIGNED: TPILE:/JIN.>�RC _.__DATE_ I? <br /> C <br /> M1 <br /> �r <br /> 0 <br /> �{ <br /> I <br /> FIBR.DYBARTMRNTURRONLY ... w - ,••� s <br /> APPLICA��TGGION ACCEPTED BY. 9A— <br /> fir,fTil QR SUMP W 5PECT�D BY: A-m <br /> FINAL IVVNSPBLTION BY: <br /> COMMENTS: <br /> PECOOS sC AMOUNT CIIECXIE 1 RKEIVIJDBY DATE SrPnC IOM <br /> MPO 11 RP r[`TED CASH <br /> V . <br />