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LIQUID WASTE PERMIT <br /> SAV IOAQUIN COUNTY PUBLIC HEALTH SERVICES 1;NVIRON%IENTAL HEALTH DIVISION <br /> 3N WEBER AVE..3"PI,OOR,StOCKTON.CA 95202 (2091463-3420 <br /> _ c NON-RR"INDABI E PERMIT EXPIRE <br /> `S,1 YEAR FROM DATE ISSU <br /> JOB ADDRESS f J C -',96,cT/�) � <br /> CIPS 2IP_ Lin ) ___L_ 9-�S�z PA RCEI.SIZFIAPN <br /> / OWNER NAME T:�F,714 lAJ1\ _-.��u• _AUURESS - __ <br /> CJ1TY/ZJP_ _PHONE <br /> CONTRACTOR ADDRESS <br /> CTTY23P PHONE <br /> GEOGRAPHICAL INFORMATION:COORDIAN7FS: X Y TOWNSHIP_RANGB_SECIION__ <br /> PERC TESTIS)I )HOW MANY APPLICAIIONN: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIWADDITION &&"R 71'THT OUT OF.S`_rm cs <br /> INSTALLATION WILL SERVE.: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:._ NUMBER OF BEDROOMS_ NUMBER OF EMPLOYEES:— <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET PI I7SUMP SOIL CHARACTER: _ WATER TABLE DEPTH <br /> ❑SEPTICTANWCIREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTME;NT3 <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL. FOUNDATION—, PROPERTY LINE- _ <br /> ❑LTFTSTATION SIZE_ TYPFOFPUMP__SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACHING LINE Numnrit&I.F.NOTII OY'LINrS__J INFILTRATOR CHAMBERS i- <br /> DISTANCE TO NEAREST: WELL FOUNDATION—— 'ROPERTY LINE <br /> ❑FILTER BED WIDTH_ _ LENGTH_ __ DEPTH <br /> DISTANCE TO NEAREST WELL FOUNDATION:_ PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION _PROPERTYLJNF_ <br /> 11 SEEPAGE SEEPAGE PIIS WIDTH LENGTH DEPTH <br /> DISTANCE 710 NEAPY-T: WELL FOUNDATION PROPERTY LINE <br /> ' LQSIJMPS WIDTH LENGTH DEATH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DLSPCXAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEA REST: WELL —FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL IKE DONE IN ACCORDANCE WITH SANIOAQIJIN COUNTY <br /> ORDIANCES,STA WS,A 06PIULES AN NS OF SAN JOAQUIN COUNTY. J� n �}U' <br /> SIGNED TL <br /> TIE-u 7 I 1'-960 <br /> � "l <br /> c let- <br /> t4- - <br /> r--�4r <br /> y Po IPA 'ME sKONLT <br /> APPLICATION ACCa TED PY: DATE: <br /> TANCPTT,O: S:IMINSPFLUATE <br /> PMOL <br /> COMMENi9 <br /> '\ <br /> PE CODE SC AMOLMT CIMCKN RECENBD IBI DATE 9ERMTTKERVR`E REOLFSTI SF717C IDY <br /> MNDr.Mlmn CASH <br />