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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALT}I SERVICES ENVIRONMENTAL HEALTH DIVISION I / <br /> 301 E.WEBER AVE.,3RD FLOOR.STOCKTON,CA 95202 (209)468-342-06 9 o 2 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED + �l'J I `t <br /> JOB ADDRESS_ II olive, GV f <br /> CITY/LlP___ <br /> R.�P�n „� <br /> PARCEL StZFJAPN__��_�� <br /> OWNER NAME_ !Nl 'i f �! 1 ADDRESS -15 q <br /> CITYMP <br /> PIIONE -:3 <br /> H�{ <br /> CONTRACTOR__ (�/ /�►�r/` ADDRESS_Pa. 6yx_ � <br /> CITYrLIP :M t rl•�./r `GY7— ��� <br /> PHONE_- 3 <br /> TT t/ L <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP_RANGESECTION <br /> PERC TEST(S) ( ) HOW MANY APPLICATION M: <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: &VM5!5DENCE Cl COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOI'fFS <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: -;,-F y PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> + ❑SEPTIC TAN K/GREASETRAP TYPE/MFG ig f CAPACITY� -j NUMBER OF COMPARTMENTS C <br /> / � <br /> ❑PgG TREATMENT PLANT DISTANCE TO NEAREST: WELL��� FOUNDATION�a� PROPERTY LINE__ <br /> ❑❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1dLEACHING LINE NUMBER&LENGTH OF LINES_�_/ �O/ INFILTRATOR CHAMBERS <br /> 1 <br /> DISTANCE TO NEAREST: WELL, LO4I FOUNDATION- DROPL-RTYLINE___ <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Cl SEEPAGE PITS WI6TH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑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 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUN <br /> ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: wb TITLE:---------- ------------ <br /> ���ISGf6 J� DATE: �Cl <br /> Vv <br /> ------ -44 <br /> S-Y <br /> 6h <br /> V 1 <br /> I <br /> _�- <br /> t� �. <br />