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LIQUID WASTE PERMIT <br /> SAN XIAQUM COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> ` <br /> 301 E.WEBER AVE 3"FLOOR.STOCKTON,CA 9520212031 RAIZ-Mn <br /> // �N-REFUNDA BLE PERM IT EK FIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS P (>J! V1 D2 AIN Pbg S <br /> �+--r4 CL PARCEL SIZE:_ <br /> �-• �j+}� ZOY(Z OC9 /� <br /> IRR CFFYFGP !Y}�/(J.f�)nn -C'Y}i �'J ✓JET BUILDINGPERMT <br /> OWNER NAME f"j KUCL' �CZ�S �/ ADDRESS <br /> CITYMP <br /> ` PHONE NUMBE <br /> CONTRACTOR olz ill/—�� ADDRESS_ Z!i/d/> TACKTi/' <br /> CITY?AP e,&I,� L4 PHONE NUMBER <br /> - GEOGRAPHICAL INFORMATION: COORDINATES:X V TOWNSHIP_MNGE�SECTM)N <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION /RESIDENCE <br /> REPAIR/ADDITION NUMBER OF BEDROOMS: <br /> y D COMMERCIAL - <br /> O DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEEREWALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 31: PIT/SUMP SOIL CHARACTER: WATERTABLE DEPTH: <br /> ❑ PERCTEST,SI HOW MANY APPLICATIONS <br /> ❑ SEPICTANK TYPEIMFG_ FI�4 CAPACITY O dLX OF COMPARTMENTS oG <br /> (3 CREASCTRAP TYPE/MFG CAPACITY XOFCOMPARTMEMIS <br /> ❑ PKGTX PLANT DISTANCETONEAREST: WELL_ <br /> FOUNDATION_ PROPERTY UNE_ <br /> ❑ LIFTSTATION SIZE TY.0I`1UMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE BOF LINES: LENGTH OF LINES:, (�A ' ourAxCRWMURM: WELL FOUNDATION/®/ 7 r <br /> PROPERTY UNE 1 <br /> INFLITRA/TSOR CHAMBERS: ��AA �j�/r� ��) -gyp <br /> ❑ EILT@R BED WIDTH LEHf:TII DEPTH_, L Du NCE TO N[M[m: WELL(y[/ FOUNDATON�� ¢ J <br /> PROPERTY LIN <br /> ❑6. �(MOUNDED WIDTH , LENGTH DEPTH q[TAnc[TOrvuH[Ei: WELL FOUNDATION_ PROPERTY UNE_ <br /> _A SUMPS WIDTH_ LENGTH DEPTH_ DEeTAxee TOxeu[AT: WELL FOUNDATION_ PROPERTY LINE_ <br /> {I ❑ DISPOSAL PONDS WIDTH_ LENGTH_ DEPTH_ Du-[AxcETO rv[ARUT: WELL_ FOUNDATION PROPERTY THE <br /> LE3SEEPAGEPITS E .0R.- Om" OL[TAx[ETOn4N R; WELL_ FWNDATION ' PROPERTYLINE- <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> MAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> L MINIM 24 HOUR ADVANCE NOTICE REQUI RED FOR I NSPECTIONS-PLEASE CALL(20S)tlSB-DAM V�l <br /> SICNED: 4 TITLE:. DATE:/UZ\ <br /> L <br /> VAL <br /> ` -MMME HULIHXVII.OR <br /> id <br /> 111111 , 11A . 1 illif-1111 11 11111iii-4t� <br /> DEPARTMENTFU4EON <br /> APPLICATION A(CEITED BY: GATE / / (//'ARR[AEM�PLO�YEEIW OLtiTRI1JICATION� <br /> INSPECTEDS DATE//� w�g PERMIT HNAC'P YES DA E-yg, z E <br /> COMMEPLJL <br /> PEfODE 9C INFO ANOVNT CXFL M RECEIVED PATE pEPMITiSEHVICE R.W.T. INVOKE[ SFPIICIOY <br /> REMITTED BY <br /> 24 0'ff <br /> RJ.II-IR.I <br />