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LIQ! WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIAWEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION �r <br /> 304 E.WEBER AVE..3R1 FLOOR.STOCKTON,CA 95202 (209)469-3420 24. VAR r\l c,. <br /> �•J' NON- EF ABLE PERMIT EXPIRF. I YEAR FROM DATE ISSUED R A C-D U Y'_ <br /> JOB.ADDRESS , L•1 <br /> CITY/ZIP I` PARCEL SIZE/APN twl SS <br /> OWNER NAME IC) (- I '✓1 JI At I lY l f_�_ADDRESS <br /> CITY2IP D on r (I PHONE (t l .�C.% 1 1 C� / <br /> CONTRACTOR� I t C 1" ICS\cr ccn 4'CC j V'("'--ADDRESS <br /> 11 '(L �l-C\/•\ -�y6 V- <br /> CITYIZIP � � <br /> PHONE- LJ J3(/ 7 <br /> _�-' �1 6 J <br /> GEOGRAPHICAL INPORSIATION:COORDIANTES: X Y TOWNSHIHIP {_RANGE_SECTION/,� <br /> PERC TESTIS)VOW MANY_ APPLICATION- <br /> TYPE OF SEPTIC WORK: ❑ NEWINSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Cl RESIDENCE ❑COMMERICIAL ❑OTHER <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 /> ❑SEPTIC TANKIGREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE-- <br /> 0 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSITM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE .� <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST:WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH ,1 <br /> DISTANCE TO NEAREST. WELL FOUNDATION PROPERTY LINE---- <br /> 13 <br /> INE___❑SEEPAGE PITS WIDTH 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 /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDI-ANCE ATE LJJAW�'Sn,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED:(l0/1(A�/Y ' TITLE:�s���OCI CT DATE:7,2G <br /> --- <br /> t i <br /> Lj <br /> I $ s P I --- <br /> �I <br /> r I =I•—Y 8 --- <br /> �+ !gA <br /> \ ----------------1-L------- ------------ <br /> ED <br /> ------ ---- - <br /> P <br /> � lt-� 777�rriii <br /> NK.P TfON ACCEPTED BY: o 17-"x-- _.f��._-_. .___ �I'�:a I E � y � <br /> I J <br /> IT.OR SUMP SPECTED BY: - DATE <br /> �FBJAi rmPECTIONBl'! <br /> CONINIEWS <br /> t' PECODE SC AAIOL'NTCHECK+i,- RECEIVED BY DATE PERNIMSERVICE REQUEST N SEPTIC IDv <br /> ' INFO REMITTED <br />