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LIQUID WASTE PERM'' <br /> 940OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMEN%4EALTH DIVISION -, <br /> 304E.WEBER AVE 3""FLOOR,STOCKTON,CA 95202(209)468-3420 <br /> ^ D A ' �L N CUNDAB,I,E p EXPIRES 1 YEAR it�FROM DAT UED �/j <br /> J08 ADDRESS CJT �' �J,\L� L/D 7 � �V PARCEL SIZE: <br /> CITY/ZIP G V BUILDING PERMIT#JF ^ <br /> OWNER NAMETe C �� (J ADDRESS `//�W�.Y� <br /> CITY/ZIP PHONE NUMBER ./J (^ 1 L_1yv� p <br /> CONTRACTOR ADDRESS l I "'/'CITY/ZIP PHONE NUMBER q,?q- <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:/ <br /> ❑ NEW INSTALLATION T RESIDENCE NUMBER OF BEDROOMS: <br /> REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTEROF SOIL TO DEPTH OF 3' A Q'A PIT/SUMP SOIL CHARACTER:CIA'y iT�-YACC WATER TABLE DEPTH: h <br /> ❑ PERC TESTS) HOW MANY APPLICATION# 'Y,,, <br /> X SEPTIC TANK TYPE/MFC00i f— CAPACITYO�O #OF COMPARTMENTS, <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOPPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINE #OF LINES: I LENGT OFHLINES: DRTANCETONEARM: WELD FOUNDATION-20PROPERTY LINE 150 <br /> FLITRATOR CHAMBER : <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCETONEARE.NT: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH Di DISTANCETONEARERT: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH Di DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> `❑ DISPOSAL PONDS WIDTHQ I-ENGTH DEPTH DISTANCETONEARM: WELL ` FOUNDATION PROPERTY LINE <br /> SEEPAGE PITS # - DIAMETER DEPTH_2-S7 ` DMTANCETONEARM: WELL 1✓a leFOUNDATIONS PROPERTY LINE�J 11 (1 <br /> (-I 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 COUNTY. <br /> I U 4 U A CE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL 1209)468-3423 �1 <br /> SIGNED: ( /' TITLE: DATE:/O—/6 <br /> OV <br /> ..r _ <br /> Ikt <br /> � , - - <br /> I -r <br /> �� <br /> I � 5 <br /> 7 -- <br /> �{ <br /> + + - Wer 2 <br /> I+ p ' <br /> IL <br /> It... <br />