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LIQUID WASTE PERMIT <br /> SAN IOAQUINCOUNTY PUBLICtlEALTHSERVICBS ENVIRONMENTAL HEALTH DIWSION , <br /> NA E•WEBIM AVE.}0.O FLOOR.STOCKTON.CA 4i1(12 (2%)463.3420 24 A R NC)-TN _,_ E <br /> NON-REFUNDABLE PERMIT ERPIMS I YEAR FROM DATE <br /> SOBADDRFSS t'$Ofe eItgpe .6it- <br /> CET`,'21P�:�-�OCf_� ,[� AARCEL 5IZPfAPN_�.i'��G��S� �CST Ci t••�'�I <br /> OWNW.NAME "'*'FJv �,��►yZL`.._._.M.LOR _ADDRESS I�OO ... Y:.;3:IE:-..�� _ — <br /> I <br /> rJ 10- 4e!9S-45/19 <br /> CONERACTQi .ZN-C�AODRESS <br /> I <br /> cITY2IP L.O CJ+I 45 4D PHONE_ 226e— <br /> GEOGRAPHICAL INFORMATION:COORDIANTE$; X _�Y_..___'WWNSHl._RANGE SE(,WK <br /> . FERC MT(S)Z )AOW MANY - APPLICAMN*. <br /> TYPE OF SEPTIC WORK ❑ NEW INSTALLAMON IL AfPAIWADD:TION C7 DESTRUCTION <br /> 1NSTALLATJON WILL SERVE: JPmsIDENCE ❑CCI.MMMICIAL CH OTHER <br /> NUMBER OF I.1 viNG'UNm.:_L— NUMWiiR OF BEDROOMS, I NUMBER OF EMPLOYEF.S!'@` <br /> CHARACTER OF SOIL TO A DEPTH'Or3 FEET. gtl P1TISUNPSOILCHATtAC'FER^��M'.._.., WATER TABLE DEPTH$fit <br /> EPTICTANJUOREASETRAP TYPFJMFCi,f'Ki4S-LyJ_�CAPAPA'TY_—_ NU.MBEROFCOMPARTMENTS <br /> 0PROTREATMEN:TPLANT DISTANCETONEARAST: WELL FOUNDATION AROPERTYLINL. __,„_ <br /> OUTSTATION Sm. AWEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTSKI). <br /> XLEACHLNGLINE NUMBER&LENGTH OFLINFS J 7 4NFft-TSATORCHAMBERS <br /> DKTAYCETONEARBSf: WELL_. —I- kXUNLtATION_ +ft7�-ROPERTYLINF. <br /> ❑FILTER RED WIDTH_ LENGTH usm <br /> DISTANC,E,IO NEARM,.WELL _ FOUNDA'I[ON:,.­_...,._.PROPERTY LIME <br /> II MOUNDED FTOTH LENGTH UEPTH <br /> b%TANCETONEARF8T: WELL �_FOUNDATION _.._..._.PROPF_RTY LINE— - <br /> 9-REEPAGE PITT WIDTH . C�1lPtFl _^DEPTH Zi <br /> DISTANCE TO NEAREST: WELL /pD 'f". FOUNDATION PROPERTY LINE 2O!„_- <br /> O SUlTPS WU7PH LENGTH DF.PTK <br /> DISTANCE TO NSAREST: WTI.l FJUNDXTTUN PROPERTY IJNTi <br /> C3 DISPOSAL PONDS WIDTH LENGTH DEPTH — <br /> DISTANCETONEARESM WELL _FOUNDATION­­PROPERTY LINE__ <br /> I HEREBY CERTIFY THAT I HAVEYREPARED.TIM APPLICATION:AND TL+E WORK WILLBE DONE W ACCORDANCE NI'TYH SAN JO&QUIN C011MY <br /> ORDIAHCES,ST MD RC1L A� ANq'REOCILAWONS OF SAN JOAQSIIN COUNTY- <br /> -N--"'�'�• c"'S�-�•- 7'ITi.6 C1'�'1 101_-"nddl `'O'«6�ATE_�'$��L. <br /> D <br /> i Ila <br /> f l <br /> 1 <br /> i I i <br /> i <br /> f <br /> I I I I <br /> fl <br /> ol <br /> 1 <br /> f <br /> i <br /> i f � <br /> , <br /> I <br /> . /^-� .F6H P BitdP,1!TT U3R DHLY RECE! <br /> AP <br /> PIACATtDN:ACCEPCEDSY: a. f'3 <br /> TANK PR OR SUMP D:SPBGIT-n By:­­­­ _ - - �—.._...._ -.4�-f flM_.x Al <br /> + S JUW CGUNIY <br /> ODMMTiM'I'S: _ PUBIC HFJIl M Ccj ..._..._-._..-- <br /> NMEPITAL HEALTH OPiIBII'++• <br /> Pi_CUDE SC AMOUvr RFIEIVEDBY DATE PERMII•SBAVICEAEITUE$II SBFMMM <br /> GVfO R'EM. .. <br /> I <br /> II , <br /> It <br />