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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVIS11 <br /> 304 E.WEBER AVE'..IRO FLOOR,STOCKTON,CA 95202 (209)468.3420 '14, <br /> NON-REFUNUABLE PERNUT EXPI R '1 YEAR FR TE ISSUED R E C:)UE S-T"[HLD <br /> JOB ADDRFSSSS_LQy`T�/��^./�* FCS r--16j thL <br /> CrtY2TP 1C�--F' 1 (ALVJ. IC.)J\J <br /> PARCEL-SIZE/APY ` <br /> OWNER NAME ADDRFSS�� <br /> Tj <br /> CTT'yfZIP- ( C/IV PHONE <br /> --- - <br /> CONTRACtT�O61 0./ /'�/�s - ADDRES. <br /> CTTY/LIP ✓'I(rC D� — PHONE <br /> OEOGRAPHICAL INFORMATTON: COORDIANTES: X Y TOWNSHIP RANOE_,SECITON_— <br /> PERC TEST(S) ( ) HOW MANY _ APPLICATION 0: <br /> TYPE OF SEPTIC WORK. ❑ NEW INSTALLATION 0. RFPAIR/ADDTTION 0 DESTRUMCIN <br /> INSTALLATION WILL SERVE; ❑RESIDENCE O COMMERICIAL O OTHER <br /> NUMBER OF LIVING UN[TS:_ NL ER OF BEDROOMS NUMBER O�E'M.PLOYEES.* <br /> CHARACTER OF SOILTO A DEPTH OF 3 FEET:�1PIT/SIIMP SOIL CHARACTER- T-4VATER TABLE DEPTHS___Q <br /> D SEPTIC TANVjUREASE TRAP TYPEIMFG CAPACITY NUMBER Or COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL— FOUNDATION PROPERTY LINE <br /> O LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) . <br /> / <br /> AXACHING LINE NUMBER&LENGTH Of LINEt S 1 I 1� INFILTRATOR CHAMBERS <br /> DISTANCE M NEAREST: WEL6 11 ► FOUNDATION 15 0 - "ROPERTY LJNE <br /> ❑FILTER BUD WIDTH LENGTH DEPTH <br /> DISTANCE'TO NEAREST: WELL FOUNDATION:_ PROPERTY IjNE <br /> ❑MOUNDED WIDTH LENGTH_ DEPTH <br /> DISTANCE TO NEAREST: WELL I-OUNDAT!ION PROPERTY LJNE <br /> ❑SEEPAGE PITS WIDTH LENGTH — DEPTH <br /> w DISTANCE TO WELL �FOUNDATION PROPERTY UNE <br /> SUMPS WIDTH LENGTH DEPTH -- <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH I-ENGTH DEPTH _ <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> I HE ERTIWY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK W[LL BE DONE IN ACCORDANCE.WITH SAN JOAQUIN COUNTY <br /> OIL E L REGULATIONS OF SAN JOAO')1N COUNTY. <br /> SIC, TITI, DAIEI] 7G_ <br /> s � <br /> -I i <br /> sr <br /> I HO <br /> i <br /> R DE LSH ONLY PAYMLN <br /> APPLICATION ACC•ZPTflo BY: '� RE EIV c CP DATE: b <br /> TANK.PM OR SUMP NSPECTID BY: n 17 6 z1) <br /> E- <br /> FINAL 1NSPTION BY0. ! �S�� C <br /> COMMM.S: T <br /> PUBLIC HEALTH SERVICES <br /> PEC,ODF- SC AMOUNT Cl ff_CKa RECF'JVFD BY DATE PERmrrISFRV1m RDQUEST• SEVM 1P4 <br /> INFO RYMITTID <br /> ��li�s W r s/ <br />