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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE.,3"D FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> 1430 LW, QaK AILo D) <br /> K <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS G % lI(.� Or4v RP f O udc » of 07 <br /> CITY/ZIP �VyJ / PARCELSIZE/APN U' ` <br /> Co Q <br /> OWNER NAME v `� r S ADDRESS 2� �1��4 <br /> CITY/ZIP PHONE 15,34— ATFL z: z7o e, w-L4!z P <br /> CONTRACTOR ADDRESS Z? J'Iu"S fug ���► 6 l!� <br /> CITY/ZIP d 1 �5 ,f 2 PHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP RANGE SECTIIONN <br /> PERC TEST(S�HOW MANY� APPLICATION#: 18 ~ 03 <br /> OQIJ U IT� <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEE.$: i <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH N <br /> ❑Siumc TANK/GREASE TRAP TYPE/MIC ____ _-_ CAPACiTY­ _NUMBER OF C0MPAR'1'MI;N'1'S_ ___ T <br /> ❑I'KO'I'ItIiA'I'MIsN'I'1'I.AN'I' DISTAN('ETO NI:ARIiS'I': WIILL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) � <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 0 <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 PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUIVIPS 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 /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE VILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE LAWS,AND MULES AND REGULATIONS UIN COUNTY. <br /> SIGNED: �� !' _____TITLE: DATE: L/7 <br /> -vr <br /> s <br /> p lM ONE OD. <br /> • I7. �3 • lO, �• A J <br /> y, 30/ <br /> J 14rt N4Jt i i -5. <br /> E <br /> �7 <br /> a.a 3.3�C I " 3 i i� <br /> 101_ M g .4 1 J <br /> y <br /> FOR DEPARTMENT USE ONLY y` <br /> APPLICATION ACCEPTED B DATE: <br /> TANK.PIT.OR SUMP SP Y: �^ DATE: <br /> FINAL INSPECTIO BY: C �/ <br /> i <br /> COMMENTS: <br /> PE CODE SC AMOUNT CHECK#/ RECEIVED BY DATE PERMIT/SERVICE REQUEST# SEPTIC IDR <br /> INFO REMITTED <br /> �-22� <br /> 521 356 3.33 0034- 5 <br />