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LIQUID WASTE PERMw-T <br /> �C JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMI,/.HEALTH DIVISION <br /> �7 304 E.WEBER AVE J FLOOR,STOCKTON,CA 95202�468-3420 <br /> NON-R <br /> JOB ADDRESS / �J/7- Al. q�rO Ln�,AS ABI,f:PF�RM;T EXAPPNEh OEA7 FROM 7AOTErISS � PARCEL SIZE: �'• _` <br /> CITYIZIP /'d ! y� �L�BUUILDING PERMIT 0 <br /> A4avc L �a <br /> OWNER NAME c�.�•^ d /�'1� Q ^ �j ADDRESS <br /> -��`v-P"�.j-��l_ c � i S 714.1ONE NUMBER <br /> CITY/ZIP -' / <br /> CONTRACTOR �^ �• /-� ADDRESS �CJ•a <br /> CITY/ZIP -S Gk A f K.. N�JL , PHONE NUMBER 44 f) `tel -- � <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 <br /> NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> FERC TEST(S) HOW MANY '2- 4 <br /> APPLICATION# 1 R - 07- a <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES:_ DINTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCETONEAREAT: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ UINTANCETONEAREAT: WELL FOUNDATION PROPERTY LINE lc <br /> ❑ SUMPS WIDTH LENGTH DEPTH DIRANCLTONEAREST: WELL_ FOUNDATION PROPERTY LINE {I <br /> ❑ DISPOSAL PONDS WIDTH UNGTH DEPTH_ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE V <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. n <br /> MINIM UD 24 HOU ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2")468-3423 <br /> SIG_NED: _ TITLE: GDATE: JP-ix <br /> O'L ( <br /> t <br /> t <br /> { - <br /> e <br /> 4 ._ - _ - <br /> 1 <br /> . �' F'�O v -.�__ __ I - I .. <br /> } 10 <br /> _-- <br /> -. _ r <br /> —� <br /> -41 <br /> rt - r r i <br /> fi _ q_, r <br />