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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH.'IBM <br /> 20R E WEBER AVE 2'R FLOOR STOCKTON,CA 95202(2N)4&LUN <br /> L/ ///ANON-RLFUNDA�BfL6�P(F,RMITC%PIREE I)YEARpPROM DATE ISSUCO <br /> JOBAD0RF5S �`'` V /,/��/� l /— PN / / //� ��� PARCEL SIM <br /> SToc/c7o� 9S2! S <br /> CPVZP BUILDING PCRITR <br /> OWNERN / ee / Q ' JJ ADDRESS 5S � <br /> CITVZP / PHONE NUMBER 3 ,- 907-30 <br /> ��- <br /> S IN 0. <br /> CONTRACTOR `'� ;� eg/S) 0' ISG. ADDRESS 672 �F, loG/6��iL. <br /> CT'ZP —144671 9�L�O PHONE NUMBER LJ 9 3(:;,C-,6!,;1SGEOGRAPHICAL INFORMATION: COORDM.:% Y TOWNSHIP RANGE SECTION <br /> TYPEOFSEPTICWORK: INSTALLATION WILL SERVE: NUMBER OF LINING UNITS:_ <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBEROF BEDROOMS: <br /> `R ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERSD/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> V <br /> ❑ PERC TEST(S) HOW MANY APPLICATIONA <br /> ❑ SEPICTANK TYPE/MFG CAPACITY ROFCOMPARTMENTS <br /> 13GREASE TRAP TYPEIMFG CAPACITY B OF COMPARTMENTS <br /> V <br /> ❑ PKGT%PLANT DISTANCETONEARESI': WELL FOUNDATION PROPERTY UNE <br /> ❑ LIFTSTATON SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> V ❑ LEACH LINE B OF LINES:_LENGTH OF LNES: RXrAXEamxu..: WELL FOUNDATION PROPERTY UNE_ <br /> INFUTRATOR CHAMBERS: <br /> ❑ FILTERBEO WIDTH LENITX OEPTH DL¢TAN[aMXGRM: WELL FOUNDATION_ PROPERTY LINE <br /> ❑ MOUNDED WI)TI LENOTH ..III_ DMAx[aTOxuRM. WELL FOUNOATON PROPERTY UWE <br /> R� <br /> ❑ SUMP$ WIDTN— LENGTH OFTX DRTAN[aMNGRPBf: WELL FOUNDATON PROPERTY IJNE <br /> O DISPOSAL PONDS WIDTH LEND _ DEPTH_ mAXRTONaARm: WELL POUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PPS M DIAMETER_ DEPTH OLRANCa TONGROT. WELL FOUNDATON PROPERTY LME <br /> EIB <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 /> (HOUR CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE: ��DATE: C <br /> L <br /> Is <br /> IA <br /> I LEE IQ <br /> 6. <br /> L <br /> r•: <br /> PU IC E H <br /> DEPARTMENTUSE ONLY <br /> E �J /�/Y ['�'[/ <br /> V APPLICATION A DATEg�` O AREA`�I EMPLOYEE IDU//�DIST0.ICT �LMATON� <br /> I NSP BY DATE �; l7 PERMURNALD YESDATE' INSPECTOR: <br /> COMMENTS: / C� <br /> ! A k <br /> PE CODE SC INTO MOUM RECEIVED DATE. PEAMIT2ERVICEAVIJUn IN VOICu SEAKIp <br /> _ 0.EMITTEO BY <br /> 22 0�sc.7 3 <br />