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LIQUID WASTE PERMIT(-) <br /> SAN JOAQUrN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL.�tEALTH DIVISION <br /> 304 E.WEBER AVE.,3"'FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1(,:0 5,0 141--1 <br /> 9 5-2-3 PARCELS IZE/APN <br /> OWNER NAME <br /> clTymP Eie-Atc'tj PHONE e 3 11,? 5 ,,:1- 3 <br /> CONTRACTOR./d t-A_4 , i-- 146- ADDRESS ZZ- <br /> PHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X_ Y_TOWNSHIP—RANGE SECTTON— <br /> PERC TEST(S) HOW MANY APPLICATION#1 U <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION 13 DESTRUCTION r4t>iL <br /> ---------- <br /> INSTALLATION WILL SERVE: 3 RESIDENCE 0 COMMERICIAL 10 OTHER f7L.-rLq_go:r <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: N^4,?N C-17 <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: --6-ay c;;Z 64"AI PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANKIGREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> Cl PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL— FOUNDATION— PROPERTY LINE <br /> 0 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> OLEACHING LINE NUMBER&LENGTH OF LINES INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL—FOUNDATION PROPERTY LINE <br /> 0 FILTER BED WIDTH - LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL— FOUNDATION:— PROPERTY LINE <br /> El MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> IJ SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 0 sumps WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL, —FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <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 /> ORDIANCES,STATE LAWS,AND RULES ONS OF SAN JOAQUIN COUNTY. b�l <br /> SIGNED: - <br /> TITLZ-PCr/J4:� MA74+4 -DATE: 3 <br /> cl <br /> 506 -- ----- <br /> 5 <br /> 5$ <br /> r-W <br /> f <br /> I L I V <br /> ar,-4 <br /> "I I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY: DATE: <br /> ...... du� <br /> TANK,PIT.OR SUMP INSPEWrWY DATE: <br /> FINAL INSPECTION BY� <br /> COMMENTS:mOA-/i5* 7 <br /> Cie <br /> PECODE se AMOUNT RECEIVED BY DATE PERMtr/SFRVICH REQUEST# SEPTIC IDO <br /> A <br /> INFO R9MITTFD SH *Xp <br /> I g -16 fl <br /> I <br /> ,I,joojH <br />