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LIQUID WASTE PERI <br /> r AN JOAQUIN COUNTY PUpLIC HEALTH SERVICES ENVIRONAL HEALTH DIVISION <br /> 504 E.WEBER AVE Y^FLOOR.STOCKTON.CA 95202 1209)AMIJ420 <br /> 404-RY,FUNDABLE PF.R EXPIRES 1 YEAR FROM DATE SSUEUi 1 / <br /> JOBADDRESS L✓�,+-��_/ / 7 , ,z2 N on - _ Ib PARCELSIZE.�Jl �I246 <br /> CRV/7Jp S^��./�//J o/ �.7RJ�C-�/�♦ 6UILDING PEILMIT <br /> OWNERNAME /L//✓it.4���.+/n_J '11Af ADDRESS \ <br /> CITY/ZIP n PHONE NUMBER <br /> CONTRACTOR �C..} /17.�_.i/i�/� /Jitn�t'2� ` die ADDRESS /b2'Ir�l �dy' <br /> CITY/ZIP 3 JdGI J/� GIT. PHONENUMBER <br /> GEOGRAPHICAI.INFORMATION: COORDINATES: % Y _TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ <br /> ❑ NEW INSTALLATION X RESIDENCE <br /> NUMBER OF BEDROOMS: <br /> ), REPAIR/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ClOTIIER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVF. <br /> CHARACTER OF SOIL.TO DEPTH OF 31: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(SW HOW MANY APPLICATION R <br /> ❑ SEPTICTANK TYPLVMFG CAPACITY R OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTK PLANT DISTA4CETONLAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIPI'JTTATION SIZE_.___ T"EOFPUMP_-. SAND OIL SEPARATOR(ENCLOSED SYSTEM)-., _ <br /> 1 <br /> LEAN LINE B OF LINES:_�LENGTH OF LINES: oLSTANCI lON[ARRRT: WELL�Q - FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS' <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ me AncLTa npYLNi: WELL FOUNDATION PROPERTY ONE <br /> ❑ MOUNDED WIOTN LENGTH DEPTH_ DIMNCR TO NRARRST: WELL_ FOUNDATION PROPERTY LINE <br /> ❑ sumps WIDTH LENGTH DEPTH_ RHTAWITONWw: WELL_ FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WWTH LENGTH DEPTH_— Pa ANCCTONGIUAT: WELL_ FOUNDATION PROPERTY LINE <br /> SEEPAGE PITS R / - UTAMETER-!� DEPT1fjr DHTANCc iONGR[ll: WELI.A2zl-. FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I NAIVE 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 /> MINIMU HOU DVANCE NOTICE REQUIRED FOR INSPECTION%-PLEASE CALL(209)463,3423 <br /> SIGNS TITLE: G�- GJ DATE: <br /> 1 , <br /> { I <br /> _ <br /> ............1............____. .�.•..._ _ ..+--•�._ - _ _ t-F._�. <br /> 4. <br /> _ <br /> �. .. • _._ -.. -. ...�. .i. _ <br /> , <br /> i <br /> �rJ:HPUGHCT DRi <br /> t. <br />