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i <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PIIJILIC IIEAI.TII SEKVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)SAN-3420 <br /> GNON-REFUNDABI.F.PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS / `+- W �!N/�'"+^yAPN 2 01 <br /> C� PARCELSITT,!2.2- <br /> CITY/ZIP_ -r-t2 IL BUIIAINC PERMITN <br /> OWNERNAME <br /> CITY'/ZIP _ _ PHONE NUMFIER , _ __� pA'� <br /> CONTRACTOR ,! LT ADDRFS.S /�"1' O <br /> [:ITYJYIP .�1l�AIt/ L/��� PHONENUMBER <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X -__Y ..-,- TOWNSHIP_-.RANGE: SEC3'ION <br /> TYPE OF SEPTIC WORK: FFF...I...N���STALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> U NEW INSTALLATIONL5IDENCL- NUMBER OF BEDROOMS: <br /> REPAIWADDITION ❑ COMMERCIAL <br /> O DESTRUCTION ❑ OTHER NUMBR.ROFEMPLOYEES: <br /> U ENGINEEKEDIALTL'KNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TESTS) HOW MANY ` APPLICATION K_ <br /> O SEPTICTANK TYPF,MFG CAPACITY 401'COMPARTMENTS OO <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY b OF COMPARTMENTS <br /> ❑ PKGTXPLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPbRTY LINE -- <br /> ❑ LIFTSTATION SIZE TYPEOFPLMr SAND OIL SEPARATOR(ENCLOSED SYSTEM)__ <br /> t LEACH LINE #OF LINES' S4- LENGTH OF LINES:-aDLRTANCE TONCARL4T: WELL e r FOUNDATION� PROPERTY INE <br /> INFLITRATOR CHAMBERS: x _ <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCRTDNEARLiT: WELL FnDNDAYION PROPERTY LINE <br /> ❑ 'HOUNDED WIDTH LENGTH DEPTH DR•TANCe TONEARR4T: WELL FOUNDATION PROPERTY LINE <br /> Ll sumps LF.NGTN DEPTH DITFAnce TT'4'FARLSI: WELI FOIINDA7JON PROPERTY LINE <br /> 7-1 <br /> Ll DISPOSAL PONDS WIDEN IENOTH DFPTH DRTAWITON941tv": WELL FOUNDATION PROPERTY LME <br /> ❑ SEEPAGE PITS K- DIAMETER DEPTH DISTAM'ETONEARLST: WFLL FOUNDATION_ PROPERTY LINE <br /> I HEREBYCERTIFY THAT(HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES•STATE LAWS <br /> AND RULLN AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM 24 UR ADVANCE NOTICE REQU1REDFORINSPECTIONS-PLLASECALL(289)463-3AZ7 <br /> SIGNED; �� TITLE: fi.c. DATE:� <br /> - <br /> , <br /> , <br /> i <br /> , <br /> • I � I <br /> I <br /> 1 ....I t S yi <br /> I ; I p <br /> - <br /> aic <br /> . 1 <br /> ... <br /> DF.PARTME NT/1J/��F./]�]N�J1.Y 7a <br /> +S7 <br /> APPLICATION AME L'D BY C�"'� AT j.�TI�A•"-ANFA^ L•MP /LDISTR L I.LICA ON <br /> INSPECTED BY:, _DATE PERMIT FINALAIF. INSPECTOA <br /> COMMENTSIa--if-T-U_Z .S II1�IJ /�.� �LSGT ,�i►'- M .. __. .. <br /> PErOOE SCINFO AMOLNI CHECKM. H AFCF.IVFO DATE INY F. ;rlc IN <br /> RF.MITTEO BY <br /> r [�o �� o0 <br /> I I <br /> REV 6[D N•1541 <br />