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LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 E WEBER AVE., 3'" FLOOR, STOCKTON, CA 93202 (209)465-3420 24- H -n GE <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED IR EA..#7.). L - zE1D <br />FC:i.r.R <br />JOB ADDR ESS i I PI L I F: 11/2 11........y 12.0 _ I R. <br />5333 4 PARCEL SIZE/APN CITY/ZIP /44.81.4 C. M.. <br />OWNER NAME SC1JIJ .6 c0t54 TC.9.1 t.I L'e" 10 03:4DDRESS t (C r( 1-:.: tit tc IX0 <br />t.' <br /> <br />.1. e CA, 1..5.-3 36 PHONE SA.1 "" 3 1 0 1 CITY/ZIPS4 <br />CONTRACTOR c r a ,,,,,y 4., tr....t. S 1 M. C, ADDRESS CZY- <br />6 s ccciol 1 C 4 ix 3 Ao PHONE ta 8- - ? 3 icT crryare <br />COORDIANTES: X Y TOWNSHIP RANGE_,SECTION_ GEOGRAPHICAL INFORMATION: <br />PR/IC TEST(S) HOW MANY APPLICATION Is: ( ) <br />TYPE OF SEPTIC WORK: 14 NEW INSTALLATION 0 REPAIR/ADDITION In DESTRUCTION <br />SERVE: 0 RESIDENCE XCOMMERICIAL 0 OTHER INSTALLATION WILL <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES <br />CHARACTER OF SOIL TO A DEPTH OF 3 FEET PIT/SUM? SOIL CHARACTER: WATER TABLE DEPTH <br />TYPEA4FCCIMC P i 4- CAPACITY licso NUMBER OF COMPARTMENTS CI SEPTIC TANK/GREASE TRAP .T.I. <br />0 PLANT DISTANCE TO NEAREST WELL I CO 4 FOUNDATION t 0 1 PROPERTY LINE 3 1 PRO TREATMENT <br />)6J-IFT STATION SIZE 113 g P TYPE OF PLIMFOrtAtt 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACHING LINE NUMBER & LENGTH OF LINES / INFILTRATOR CHAMBERS <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE .,........._ <br />0 FILTER BED WIDTH 1 S' 1 LENGTH zo 4 DEPTH ' <br />DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br />CI MOUNDED WIDTH LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />CI SEEPAGE PITS WIDTH LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />L7/ SUMPS WIDTH LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />0 DISPOSAL PONDS WIDTH LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE?' 'PA THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDIANCES, STATE LAWS, kt) REGULATIONS OF SAN JOAQUIN COUNTY. <br />TITLE: DATE dg, eo <br />PL <br />" 1' " i 5 / <br />1 I 0 <br />I. -1. <br />_. _ _ -cr... 1 i <br />o t <br />. . . <br />...,..._____....., 3 i i <br />_ <br />fib WE <br />l'il di JUN I 6- 700 <br />ill ripit,R chr )., <br />FOR DEPARTMENT USE ONLY BLIC HEALTH SERVE <br /> <br />ENVIRONMENTAL ,§kw t, 0., _..... APPLICATION ACCEPTED BY. <br />DATEINS ell - ' • TANS. PM OR SUMP <br />FINAL INSPECTION BY' Me) <br />COMMENTS' <br />PE CODE SC <br />INFO <br />AMOUNT ...".47)ile RAMITTED RECEIVED BY DATE PERMIT/SERVICE REQUEST II sErric 11). <br />41110 aso5t& . r, 66 &AL. <br />.. <br />4 <br />. .. ,.. _ . <br />61-R25.0„143.1, • <br />•