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` LIQU WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBL�/ALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE.,7 FLOOR,STOCKTON,CA 95202 (209)468-34.0 214 "R <br /> •^� NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IOBADORESs u' Aql)- EF <br /> N- Si-hiy Coktkg�--`94 fns-t-- L>>/1 !at VU FIC`)F= �L-L <br /> �CiTTY�/yLIP (''� PARCEL SIZ&jAPNN -) y� <br /> 13 12i NAME (!C\� �b,r� ADDRESS � Yi.kl <br /> CITY2IP - I i C nPHONE <br /> - CONTRACTOR L.j,E,i CTN1EnP�Y-� V1�� ADDRESS F CJuS!UYV CN <br /> CTTY2IP �G/1. #I' �Cal e'-) PHONE �� 67 322 <br /> GEOGRAPHICALINFORMATION:COORDIANTES: X Y TOWNSHIP_RANGE_SECTION <br /> PERC TEST(S)( )HOW MANY APPLICATION#: <br /> TYPE OF SEPTIC WORK: f9kZEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL -OTHER 4g kc,c L <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:__ NUMBER OF EMPLOYEES:_ <br /> - CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEP'TIC TANKIGREASE TRAP TYPE/MFG CAPACITY NUMBER OF COOMPARTMFNTS <br /> ❑PKG TREATMENTPLANT DISTANCE TO NEAREST: WELL FOUNDATION- PROPERW <br /> 11 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ����••••jjjj <br /> >_ ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS MAR 62001 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLINE <br /> SAN JOAoUT TUO,3IVTY <br /> ❑FILTER BED WIDTH LENGTH DEPTH PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> DISTANCE TO NEAREST:WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION 4 PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUNIPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH - <br /> DISTANCE TONEAREST: 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 A„Q <br /> ORDIAN ATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. a- ^ <br /> SIGNED d 1 <br /> TITLE:(dStTt� SATE: ._ <br /> t' <br /> AY <br /> um <br /> ILI <br /> r <br /> V <br /> t <br /> FOR DEP.�{tTLi1ENI USE ONLY <br /> APPLICATION ACCEPTED BY: <br /> TANK PR,OR SUMP INSPECTED BY: DATE <br /> FINAL L14SPEC ION BY: <br /> COMMENTS: <br /> PECODE SC AMOUNT CHECK N/ RECEIVED BY DATE PEANUT/SERVICE REQUEST N SEPTIC IDN <br /> INFO REMITTED CASH <br /> � 3 <br />