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XI � QuINCo LIQUIIDAWASTESERVICES EPERMI
<br /> NTY DIVISION
<br /> 304 E.WEBER AVE 3m'FLOOR.STOCKTON,CA 932021209} , 04.
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<br /> . `•7IAr /t hFUNDABi :R(!T Ei „-Fti-.1�•JY FROuM DCATFtiSSUF
<br /> JOB ADDREq � IZE: 70AP PARCELS
<br /> CTTVt7AP �L^ BUILDING PER%trtx
<br /> �L �iYl LY �1�R0 Ne
<br /> ONNER NASfE ADDRESS
<br /> CITYIZIP PHONE NUMBER
<br /> CONTRACTOR ADDRESS :ZZJ�PG��[//I r cx
<br /> CITYIZIP PHONE NUMBER
<br /> A
<br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION
<br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:
<br /> NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS:
<br /> ❑ REPAIR/ADDITION COMMERCIAL NUMBER OF EMPLOYEES: —�
<br /> ❑ DESTRUCTION;` ❑ OTHER
<br /> ❑ ENGINEERED/ALTERNATIVE
<br /> CHARACTER OF SOIL TO DEPTH OF 3' CZ�{J'zP� PIT/SUMP SOIL CHARACTER: -- WATER TABLE DEPTH. Z
<br /> ❑. PERCTEST(S) HOW MANY APPLICATION#1n ' 2
<br /> (�,/JJ SEPTiCTANK TYPEIMFC `�' CAPACITY °(/600 #OF COMPARTMENTS c? _ d
<br /> lj,� �C
<br /> /© GREASETRAP TYPE/MFG CAPACITY #OF COMPARTMENTS N
<br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELLr V FOUNDATION. PROPERTY LINE, 2,14
<br /> -
<br /> ❑ LIFT STATION SIZE TYrEOF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) -/-�
<br /> LEACH LINE #OF LINES: LENGTH OF LINES: -0 DISTANCE TONEARE,ST: WELEIOC J FOUNDATIONPROPERTY LINE-�?
<br /> /// ��~ INFLITRATOR CHAMBERS:
<br /> ❑ FILTER BED WIDTH LENGTH DEPTH DATANCETONEAREST: WELL FOUNDATION PROPERTY LINE
<br /> ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE
<br /> / f
<br /> SUMPS WIDTH, LENGTH DEPTH DICfANCETONEAREST: WELFOUNDATION/0 f.PROPERTYLINE 2'� �Y��
<br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH WSTANCETONEAREST: WELL FOUNDATION PROPERTY LINE J
<br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE \
<br /> I HEREBY CERTIFY THA E 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 /> MIN MUM 24 H ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-34x-3 / �^
<br /> SIGNED: / TITLE: DATE: ` /3 -y Z
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<br /> DFPARTM ENT USE ONI,Y
<br /> APPLICATION ACCE 4 _DATE; 10"11'L AREA_-EMPLOYEE 1DqDISTRICT ION-
<br /> INSPECTED
<br /> ON
<br /> INSPECTED DATE: 10131aZ PERMIT FINAL}- YES DATE: /U INSPECTOR:
<br /> COMMENT . ma yir -1,F/ +H ,rrUe`'S N � 2r MpQE RoeiC
<br /> PECODS SCINFO AMOS)NT L CHECK! ASH RECEIVED DATE PERM ITISERVICEREQUEST»_ INVOICE# SEPTIC IDM
<br /> / I.zr� iso 'p�Q IBI ' ®0315 -71
<br /> REVISED M•I6AE
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