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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNIY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIV1SQ4 HR N OTr C <br /> 304 E.WEBER AVE..IR FLOOR,STOCKTON,CA 95202 (209)468-34:0 REQUEl;STEC <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED FOR ALL <br /> JOB ADDMS—OO WAVERL`1 —2zAti INSPFrTtc^f <br /> CITI'/LIPV U CrN �y L3SZ� PARCELSIZE/APN 'x 376 <br /> OWNER NAME KEITH :vOg ` WTcm RESS <br /> CITYlL1P_ �y, } n- PHONE - ►+DG./ <br /> CONTRACTOR W'Dmj�L.D .7- SHOTX-mC ADDRESS 54,50 E.n mCO RJV yx <br /> CITY/LIinp�T CAIN 0 _ PHONE <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP_RANGE_SECITON��S•.. <br /> PERCTFST(S)( )HOW MANY APPLICATION II: <br /> TYPE OF SEPTIC WORK: f l NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DFSTRUCTIpJ{R J 3 <br /> INSTALLATION WILL.SERVE: CWRESIDFNCE 13COMMERICIAL OOTHER_ l 11JJ UC(JJ <br /> NUMBER OF LIVING UNITS:-L NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:__ �, ,liDUNTY <br /> CHARACTER OFSOILTO A DEF17i OF 3 FEET.C4 e6abM�F- PIT/SUMP SOIL CHARACTER: IJt; D1'IWATEA'T;YBL..,boj SiDL_ <br /> FSEPTIC TANK/GREASETRAP TYPE/MFG ftWC Zf2WFbL CAPACITY {T NUMBER O';COMPARTMENTS� <br /> 1 <br /> ❑PKG TREATMENT PLANT DISTANCETO NEAREST: WELL IoO'� FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP q SAND OIL SEPARATORtENCLOSED SYSTEM)_ <br /> 19LEACHING LINE NUMHER&LENGTH OF LINES Z / 0 D INFILTRATOR CHAMBERS / <br /> DISTANCE TO NEAREST; WELL 100'4 FOi1NDAT10N_--1_Q—PROPERTY LINE <br /> ya <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST'.WELL FOUNDATION:_ PROPERTY UNE <br /> ❑MOUNDED WIDTH LENGTH_ DEF1Ti <br /> DISTANCE IO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> D SEEPAGE PITS WIDTH _ LENGTH _DF_FTH <br /> DISTANCE TO NEAREST: WELL 1 FOUNDATION PROPERTY UNE <br /> i J <br /> bSUMPS A WIDTH LENGTH 7I :� DEPTH 27=, <br /> DISTANCE TO NEAREST: tiIE1,L /51�f FOUNDATION��L_PROPERTY LINE <br /> O DISPOSAL PONDS WIDTH LENGTH DEFT-H _ <br /> DISTANCE TO NEAREST: WELL -FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIA E LAWS ND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED��+ti TITLE: ��� DATE,- N <br /> / () <br /> o d u <br /> f`(f_ <br /> If <br /> ell 7L� <br /> � v � <br /> -61 <br /> A <br /> cb <br /> r <br /> 14?04t <br /> Tso - <br /> .2j LL <br /> OR DE ENT USE ONLY <br /> 7 h <br /> APPLICATION AC('EPTED 8Y: U DATE '• V <br /> TANK,PIT,OR SUMP INSPECTED BY' Q — <br /> DATE—FIN INSPF�TION BY/ -j/�1 /- <br /> PE CODE SC AMOUNT C:HECKV RECEIVED BY DATE PER,MTT/SER VICE REQUEST SEFIC of <br /> INFO pe,Mfi'TED CASH <br />