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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 3U E.WEBER AVE JXI FLOOR.STOOKTON.CA 9521D009JANLJRD <br /> 16636 NONREFUNDABLEPERMITEXPIRES I YEAR FROM DATE <br /> IIINSUEDD 'j J <br /> JOSADDRESS ,^ (fG(J�ARM L�fS-O(ao- LJ�.�I�/]�` PARCELSI]E: 13�acR^eS <br /> CITT2IP �(��1ITp0 C4- g53((�, f B 4AxGFERMa- PA/-� o z- Gig <br /> OWNERNAME L //Q imp, �PJ ADDRESS '1 / DOE) /a,, i z <br /> CITY." PHONE NUMBER (/z sIz,// <br /> CONTRACTOR ADDRESS yI /C- <br /> CITY2IP PHONE NUMBER _ '9 4/e -//�3 d� <br /> GEOGRAPHICALINFORMATION: COORDINATES:X Y TOWNSHIP RANGE SECTION_ <br /> TYPEOFSEPTICWORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> A NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAWADDITION R COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGNEERED/ALTERNATIVE /I�� <br /> CHARACTER OF SOIL TO DEPTH OF 3% L PITISUMP SOIL CHARACTER: WATER TABLE DEPTH:�O T <br /> PE¢CTEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTICTANK TYPFIMFG CAPACITY #OF COMPARTMENTS_ _ <br /> ❑ GREARCTRAP TYPFIMFO CAPACITY #OFCOMPARTMENTS 6' <br /> IF- 6 <br /> ❑ PRCfX PLANT DISTANCE TO NEAREST: NRLL_�� FOUNOATON1�R���Y/T PROPERTY LINEM w <br /> ❑ LIFTSTATION SIZE TYIENMNI SAND OIL SEPARATOR(ENCLOSED SYSTEM) m_ <br /> 11 <br /> ❑ LEACH LINE 0 OF LINES:_LENGTH OF LINES:_ vm.xa ToxcAUM. wELL FOUNDATION_ PROPERTY LINE LRI <br /> INFLTIRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ uRTANCLTOnaRUT: WELL FOUNDATION PROPERTY LINE_ <br /> ❑ MOUNDED WIDTH_ LENGTH DEPTH_ MSTANCETONpREF: WELL FOUNDATION_ PROPERTY LINE_ ����////````yy!!!! <br /> ❑ $UMP$ WIDTH LENGTH_ DEPTH--__ RDTIXCETOxEAEFT. WELL FOUNDATIONE <br /> _ PROPERTY LIN <br /> ❑ DISPOSAL PONDS WIDTH UENGTH DEPTH_ OIATAXCRTOM4RPFI: WELL FDUNDATION_ PROPERTY LINE_ <br /> ❑ SEEPAGE PITS N DIAMETER_ DEPTH_ 01,1ARL2TONLANMN: WELL FOUNDATION_ PROPERTY LINE_ 1' <br /> Q <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 /> AND RULES AND REGULATIONS OF SAN JOAQUIN CO UNIV. T <br /> M UM SING A'ANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASECAL 9)0E&3d21 �y�1�..,C/ J� <br /> SIGNED: L ���w TITLE: I /7 DATE: <br /> \ <br /> NO <br /> Q toi l NY o-q R <br /> - <br /> R to <br /> \\ <br /> Q:to <br /> = Ld �c <br /> O� ��' <br /> O GE I <br /> OVIA-LAIB <br /> 03� _. . <br /> nU: Z, •oN Pu..and <br /> w ` <br /> DEPARTMENT USE ONLY <br /> APPLICATION AttEPIEO BY: ,J -ATE: -Z -O1EA!a-EMPLOYEEIM 93l DIBTRI(TLOCATION <br /> IMPECFED BY: .p DATE./PERMIT DMALAB TES DATE: INSPECTOR: <br /> COMMENTS'. <br /> PE E SCWFO AMOUNT CHECKtl: SH RECEIVED DATE PERMITRERVICERE ESTY INVOICEY EPMC IN <br /> REMITTED BY <br /> 4zZti 57I 89 lis�n Z,c loibIfft, SR 0031 — 1 q <br /> RRvrsmP.w1 <br />