Laserfiche WebLink
Cf LIQUID WASTE PERM''' <br /> �^ S)IIf JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMESlfoRi <br /> EALTH DIVISION <br /> 304 E.WEBER AVE 3q1 FLOOR,.CA 93202(2 OAR-3420 <br /> ^ 1 �'� ��t� pUUNDABI.E R T EXPIRES 1 YEAR FROM DATE ISSUED <br /> 7 <br /> n/(l -/ I 00/J,� ���[/ - 7/b fV PARCEL SIZE: � <br /> JOB ADDRESS <br /> CITY/ZIP C BUILDING PERMIT 0 coo ��,�.�� <br /> OWNERNAME I , / A L ADDRESS <br /> PHONE NUMBER <br /> CT7ZIP / 11 <br /> .nJ Sid D <br /> CONTRACTOR _ � ADDRESS 1 h <br /> � CEJ!^ <br /> CITY/ZIP�_�YA�'jhPHONE NUMBER <br /> - GEOGRAPHICAL INFORMATION: COORDINATES: X <br /> Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ <br /> NEW INSTALLATION 19- RESIDENCE NUMBER OF BEDROOMS: 2 <br /> ❑ REPAIR/ADDITION O COMMERCIAL NUMBER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEERED/ALTERNATIVE <br /> n ` / <br /> CHARACTER OF SOIL TO DEPTH OF 3'• �a'�i Af1 �1"MT/SUMP SOIL CHARACTER: /� / -� WATER TABLE DEPTH:1(p1i <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> SEPTIC TANK TYPE/MFG A CAPACITY 7 tJ #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY <br /> #OF COMPARTMENTS <br /> r <br /> ❑ PKCI'X PLANT DISTANCE TO NEAREST: WELL-7±r FOUNDATION 7-6 PROPERTY LINEA !) 4- <br /> ^F <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) .� <br /> #OF LINES: LENGTH OF LINES: oUWANCETO NEAREST: WELL/ FOUNDATION—al— PROPERTYLINE .�(�/ , <br /> LEACH LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEP"_ ULSTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ Dt TANCETONEAkEST: WELL_ FOUNDATION PROPERTY LINE V, <br /> ❑ SUMPS WIDTN LENGTH DEPTHDIWANCETONEARENT: WELL_ FOUNDATION PROPERTY LINE �`FFFJ <br /> DISTANCETONEARKST: WELL / FOUNDATION / PROPERTY LINE Il <br /> ❑ DISPOSAL PONDS WIDTH LENGTH h DEPTH_(( / !!-�!�/ / IA1\I' <br /> k SEEPAGE PITS # <br /> DIAMETER DEPTHOLoIFTArvG[TO NEAaENT: WELL L/ r FOUNDATION `� PROPERTY LINE 'S <br /> 1 HEREBY CERTIFY THAT 1 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 /> MINIMU HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PL SE CALL(209)468-3423 �? <br /> r <br /> SIGNED: TITLE: DATE: �`• <br /> L <br /> lei L <br /> l3c," - <br /> -, -- - <br /> PAP- <br /> 0 <br /> f <br /> 4 � <br /> @NVI ON — <br /> } <br />