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LIQUID WASTE PT -MIT > �� ����� <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES EN�MENTAL HEALTH DIV <br /> 1. .' 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 93202 (209)468-3420 S--E <br /> NON-REFUNDA RLE PERMIT EXPIRES I YEAR FROM DATE ISSUED FCDR A L L <br /> JOB ADDRESS fi" I LsV//(,Yf'. <i„L'✓G :� 6NSPECT[ON�` <br /> CITY/LIP T ✓J Gam/ PARCELSIZFIAPN .✓'� <br /> "r 6 <br /> OWNERNAME 1>A✓✓ /tJ'] G-% ADDRESS <br /> CITYMP A PHONE_ " <br /> CONTRACTOR �4 Li `1/L L C% ADDRESS Pe) <br /> CITY/ZIP PHONE <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHiP_RANGE_SECTION <br /> PERC TESTIS)( )HOW MANY APPLICATION#: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:,, NUMBER OF EMPLOYEES:_ <br /> .,r CHARACTER OF SOIL TO A DEPTH OF 3 FEET: A TJ C/3 CT' PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> ❑SEP71CTANK/GREASE TRAP TYPEIMFG P,..4-/-, CAPACITY Z,-;2 NUMBER OF COMPARTMENTS_ <br /> -- ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL�1(j.L7 r FOUNDATION_ PROPERTY LINE .S C� <br /> 13 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Iq LEACHING LINE NUMBER&LENGTH OF LINES /� L�-Cl INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL 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 /> ❑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 <br /> O <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 /> ORDIANCES,STATE LAWS,ANP RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. �j y <br /> SIGNED: e TITLE: —V�K'L _.,. DATE: <br /> \�1 <br /> zs <br /> f <br /> 157 W <br /> 1 <br /> �ani <br /> r <br /> Z N l <br /> r FO DEPARTMENT USE ONLY P <br /> APPLICATION ACCEPTED BY: r EI"ED DATE:`~7 _ <br /> TANK.PIT.OR SUMP INSPECTEDzoob DATE <br /> FINAL INSPECTI�ONN BY' _ <br /> .... <br /> Comm ENTS: / / / COM .8 O(, /(J/� YI!!arA la� O <br /> !, F !,C SQ ou cicy wr PUB RiDI Df/ 1. <br /> PECODE SC AMOUNTCHECK RECEIVED BY GATE PERMIT ERVICE REQUFSTN SEPTIC IE.1E <br /> INFO ReWITD ASH <br /> �Zld rid 'a ���-'1 - 7r 1 <br />