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LIQUID WASTE PERMIT SEPTI( <br /> � SAN JOAQUIN COUNTY PUIIUC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 300E.WEBER AVE 3-FLOOR,STOCKTON,CA 93202(2W)46v-42D <br /> . ,wNqN-REF DA F.PF:Ry % ES YEOM DATE <br /> JOB ADDRESS_ a )e.D_1�RCFL SIZE: <br /> CTYJGP_ �,Lf <br /> S,6'"�f�'�'�5 BIRLDING PERMIT O ^ W A O 1 3 2-Y — <br /> OWNER NAME- 13.BC r+ ! 1 ADDRESS <br /> CTTYlTJP /OZA (�� Z PHONE NUMBER <br /> CONTRAC—FO_- ToADnaEss <br /> CITYlZP1Ll�/aV, �i�.✓✓iCi._. t1 i <br /> Tj3ST PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION:COORDINATES:X Y_---_ T0AIMSHIP_ ,RANGF. SECTION .. <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF VING UNITS: <br /> ii NEW INSTALLATION fro RESIDENCE NUMBER OF EDROOMS: <br /> ❑ REPAfILADDITION ❑ COMMERCIAL <br /> O DESTRUCTION ❑ OTHER NUMBER OFPAPL.OYECS: <br /> ❑ ENGWEEREWALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': AnJ PITISUMP SOIL CHARACTER: VTER TABLE DEPTH. <br /> ❑ PERCTEST(S) HOW MANY APPLICATION# <br /> $ SEMCTAryIt TYPE/MFGX <br /> }� CAPACITY /GCYJ #OFCOMPARTMFNM_?_ <br /> ❑ <br /> GUASE TRAP TYPEIMFG CAPACRY *OF COMPARTMENTS <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL FOL%DATION PROPERTY LINE <br /> ❑ LIF[STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) �- <br /> A LEACH LINE #OF LINES: G�r <br /> ► LENGTH OF LINES: t / <br /> DI}TANC7 TO NEARCST. WELL FOUNDATION PROPERTYLINE <br /> INFUTRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH ROIPANCE TO WARe .. WELL FOUNDAiON PROPERTY LINE <br /> O MOUNDED WIDTH LENGTH DEPTH— R6 CE'IU NEARffiT. WELL F UNDA'IION PROPERTYLINE <br /> I <br /> ❑ SUMPS WIDTN LENGTH DEPTH DOT"TO'NYARPiT: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH�7 D=MCLTONRARR4F. WELL FOUNOA77ON PROPERTY LINE <br /> Q SEEPAGE PEPS # �1 DIAMETER 2 DEPTH G .YT <br /> 1 DANCtTOWARECr, WELL eS& FOUNDAjIION ly, PROPERTV LINE A3 <br /> 1 HEREBY CERTIFY THAT I RAVE— 1 PREPARED THIS APPLICATION AND THE WORK WALL BE BONY.IN ACCORDANCE.WITH SAN JOAQUIN COUNTY ORDIKANCES,SPATE LAMB <br /> AND RULES AND RECU W:IONS OF SAN JOAQUIN COUNTY. .,t <br /> �J MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTION'S-PLEASE CALL(209)468.3423 0 <br /> ( <br /> SIGNED:_ DATE- <br /> L <br /> r_ , <br /> ; <br /> , <br /> ' I I I � I 1• t--~-- —�---*--=--!._:. ._r- -- - -+--�—�__.;_.i I <br /> --+ t--a-- I _ I l t t (1.__� 7-=--r-r•-, I I ;-h- I I ,--•---F- --� <br /> _i <br /> fi <br /> I <br /> _1__J�� I I I <br /> t- � -1-'�---t--,-...L.__h--,•--«-�__'-__J..__.1_. I—!��1—IL_11. I � I <br /> r---i__..t...__.�--t--t- -_.�--•r---__-i-i-._I I ----I--- - I ; --�-F-{-�4M- 'AO fNt -� <br /> r-j-L--- <br /> -...�.---;---?--�-r-; ! i__ T...�-{ I <br /> , <br /> _!-_L_ _--1- � i „I i h_. t I T 'T--t�I -j--�•�-_ _-{---'--��-�--i--T--j---, t <br /> , <br /> , <br /> , <br /> - <br /> �- ARTMENT USE NL.Y �{/� <br /> APPLICATION ACCE .D V: /DA L AREA/��/11—/�--11L`-EMPLOYEE IOk•*�JY�GJ dS'IRI(T�et .�ATN)N <br /> INSPECTED BY. DATE Z/ 1� PERMIT FMALO YES DgTE: INSPECTOR: y <br /> I <br /> COMMENTS: b ` <br /> i PECJDE SCMFO AMOUNT E(: ASH RECEYIVED DATE <br /> REMITT R /SERVICE RE INVOIC6- kEPTIC IDI <br /> I <br /> RRVISED IFIS�1 <br /> .. I <br />