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LIQUID WASTE PERgT' <br /> JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONML, HEALTH DIVISION <br /> 304 F.WEBER AVE 3k1'FLOOR,STOCKTON,CA 95202(20-))L468-1420 <br /> / ( �NpABL E PERMIT EXPIRES I YEAR F OT1 SUED <br /> JOB ADDRESSA_ APN PARCEL SIZE:1s <br /> CITYIZIP "'3 `-/(�-^J�UILDING PERMIT p_ � O Ll <br /> OWNER NAME ADDRESS <br /> CITY/ZIP PHONE NUMBER <br /> CONTRACTOR ADDRESS <br /> CITY/ZIP"Ir L-/y -PHONE NUMBER_�� <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y m TOWNSHIP RANGE SECTION <br /> VTY E OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION ❑ RESIDENCE NUMBER <br /> OF BEDROOMS: <br /> El REPAIR/ADDITION ❑ COMMERCIAL <br /> ElDESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> SEPTIC TANK TYPE/MFG_ CAPACITY C/O #OF COMPARTMENTS. <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS- <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE - - <br /> ❑ <br /> LIFT STATION SIZE �) TYPE OF PUMP- SAND OIL SEPARATOR(ENCLOSED SYSTEM) , 1 <br /> N <br /> LENGTH: .� OF LIES: <br /> LEACH LINE #OF LINES � DISTANCE TpNEARE$T: WELL � FOUNDATION ' PROPERTY LINE V (� <br /> INFLITRATORCHAMBER§: f( TIfI� <br /> ❑ FILTER BED WIDTH LENGTH - DEPTH DISTANCE TO NEAREST: WELL FOUNDATION- .PROPERTY LINE - - <br /> ❑ MOUNDED WIDTH LENGTH - DEPTH DISTANCE TO,NEAREST: WELL - FOUNDATION -PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH D[STANCETONEARESP: WELL FOUNDATION - PROPERTYLINE - % . <br /> ❑ DISPOSAL PONDS WIDTH LENGTH - DEPTH DISTANCETONEAlli WELL FOUNDATION PROPERTY LINE ' <br /> I <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE - <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 /> 7ii IMU 24 HADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE,CALL 2 9)468-3423 <br /> SIGNED: TITLE: DATE: - &. L3 <br /> : <br /> _ <br /> _, ...... ... , \ E <br /> ....... .. I .., [ is <br /> t ! [[f <br /> i I <br /> i <br /> i r✓ <br /> ... .,..,L, ..� ....,. -- - - .,. ., j .. ., <br /> MK <br /> 'Tr <br /> .1...- : <br /> : <br /> f ! <br /> I � ' <br /> ! ..: C t f <br /> ............ <br /> I <br /> L - I I I. . s E I <br /> ,..,., .,.........i_. <br /> : F <br /> ! I I <br /> ! <br /> R _-.-_I <br /> J <br /> 1 �Q <br /> I <br /> ... : I...... ...i.. _ .. I <br /> I ...� _.. <br /> --..... _ <br /> i r .. L I .,.,_., j, I _,. i q i .�:,._ �, _ 'SE�A a P,L E ..I.: L,._... <br /> I AIy1R T .. <br /> f : <br /> , ALS <br /> .,...� k .; - <br />-_ srl +. - _ it..,..,. <br /> , DEPARTMENT USE ONLY <br /> '.APPLICATION ACCEPTED BY': -^-^� DATE: l 6 AREA �f EMPLOYEE ID# f�S DISTRICT LOCATION <br /> INSPECTED BY: ��� DATE- - !.l PERMIT FINAL YES DATE:' INSPECTOR: <br /> COMMENTS: / O J<p'Yl..�. iuf7 j <br /> PE CODE SC INFO AMOUNTCHECKS 'ASH RECEIVED DATE PERMITISERVICE REQUEST# INVOICEN SEPTIC IDN- ly <br /> REMITTECI BY - 1 <br /> REVISED K-15.01 <br />