Laserfiche WebLink
I <br /> 1 LIQUID WASTE PERIMIT <br /> SAN JOAQUWl'OUNTV'FIJB.IC HFAILTH SLR [CES ENl'IRONNfENT;.L HEALTH DIX kSION <br /> ;Dar. WrHFRA\'R.3""rL00P_STOC}:TON.TA 9--0+,2003VOyRFFUND.IBLF.PERMIT EXPIRPS I V't:AR FRf01i UATF.l5NUF.D <br /> k JOIS AIII�RE55 „Y(/ �L1�Ci/l%r'!nL lr�/L _ AFV / pII F �/.J� PARCEL Cl7.F.. <br /> r <br /> ::1TV'fZIPC- BUILDING PERMIT'? <br /> OVT'NER N:1Nl t. ��J/p/! �.D➢KESS _ <br /> F I CITViZIP ✓/J/ / / PHONE,NUMBER r �� <br /> CONTRACTOR/["l? L /[✓�� 7c�J11'y ADDRE55 � KC�_ �✓1-: <br /> 1CITYr2IP ' -PHONE NUMBER Q <br /> Ill <br /> F-1 <br /> GEOGRAPHICAL INFORMATION: COORDINATES'. X VTOWNSHIP RANGE_SECTION <br /> TYPE.OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:�� - <br /> ❑ NEW fNSTALLATION W RESIDENCE NUMBER OF BEDROOMS:F; I&- <br /> REPAIR/ADDITION ❑ COMMERCIAL <br /> NllNIB ER OF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER <br /> ❑ ENGINEEREDIALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3•:�n�PITISUMP SOIL CRARACPER: WATER TABLE DEPTFS: <br /> 1L ❑ PERI TEST l51 HOW MANY APPLICATION <br /> ❑ SEPTICTANK TYPE/MFG �`*�&k � CAPACITY #OF COMPARTMENTS <br /> F <br /> ❑ GREASETRAP TYPE/MFC CAPACITY MOFCOMPARTMENTS <br /> IJ PKCTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Q LIPTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM}r <br /> Ft4 LEACH LINE 4 OF ENGTH OF LINES: 1 dG P D—NEETONCARET: WELLF FOUNDATION�J PROPERTY LINE_13a4�r <br /> TRATOR CHAMBERS: V <br /> C• <br /> ❑ FILTER ULD WIDTH LENGTH DEPTH DI$FANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTN DISI'ANCETUNEARENT: WELL FOUNDATION PROPERTY LINE <br /> Q SUMPS WIDTH LENGTH DEPTH oIIFxN[E TO NEARfSC: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIWANCETONEAReS! WELL FOUNDATION PROPERTY LINE C <br /> ❑ SEEPAGEPITS # DIAMETER DEPTH DESTANCITONEARE.ST: WELL FOUNDATION PROPERTY LINE <br /> i N <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS h <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 4HOURADVANCENOTICEREQUIREDFORINSP6CTIONS—PLEASE/CALL(209)468-3423 <br /> F. SIGNED: TITLE: f!j- � DATE: �l <br /> _ _ <br /> F,” <br /> I i �._I- li k � ��X•��� � I �.�L.y1�_I-i 1 ��_'^��--! 1 ',lei' 3 <br /> I _ <br /> I �.. I <br /> - r <br /> ..J ........... <br /> s._----- ._�__.. 1. -- 5 - - - -I" <br /> _ <br /> ,iL <br /> I I 11 I _ <br /> .L.- I <br /> ! <br /> a 1— I I I �/+I <br /> i . <br /> I _I <br /> L !_.J <br /> y DEPARTMENT U .Y /GJ ./ <br /> I APPLICATION ACCEPTE BY = _DATE:' EpES1PLOY EE IDE [- STR€CT LOCATEON� <br /> INSPECT DBT: DATEi'� CERM[T FiNA1 YES DATE��`G'c- SPECTOR: <br /> k <br /> I COMh1ENT5: rJ� • -� <br /> PECODE SC[NFO AMOUNT CHECK# ASH RECEIVED DATE FERMI PSER VICE REQUEST# INVOICE- SEPTIC IN <br /> RFMITIED DY <br /> 67 q <br /> Fil' <br /> RE'VSED I I S-I I <br />