Laserfiche WebLink
LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3RD FLOOR,STOCKTON,CA 95202(209)469-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS it J -1 iT�!' APN "J � PARCEL SIZE: <br /> CITY/ZIP StocLC feA BUILDING PERMIT <br /> OWNER NAME +M1 Y I���vY GCo,} ADDRESS <br /> CITY/ZIP PHONE NUMBER y • _ {� <br /> CONTRACTOR MI*Kf, F•All-cC- ADDRESS Po licit 6,q-6 <br /> CITY/ZIP im V d wk-e C J Ci✓'T CJ 3 S I= PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE F SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIR/ADDITION ❑ COMMERCIAL <br /> El ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE A ' <br /> CHARACTER OF SOIL TO DEPTH OF 3% PIT/SUMP SOIL CHARACTER: rJ<.�a�. WATER TABLE DEPTH: <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> grIl'SEPTIC TANK TYPE/MFG_ CAPACITY a #OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL�d FOUNDATION 10 PROPERTYLINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I <br /> LEACH LINE #OF LINES:I LENGTH OF LINES: fX^ I <br /> v� DISTANCE TO NEAREST: WELL FOUNDATION �U PROPERTY L)NE)ID' <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DMANCE TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> (( <br /> i 7 If1 <br /> SEEPAGE PITS #�_ DIAMETER _ DEPTH DISTANCE TO NEAREST: WELL—) FOUNDATION - PROPERTY LINE,20 <br /> 1 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. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE: C0^4& f- D A T E I- 9J <br /> C7' <br /> ............................ ......................._..._... ... .. ... ... <br /> i <br /> ...........i.............t.....................................t......... ._ ... ... ... ... .. ... _ .... ... ... .. ... _ ... <br /> i [ �f <br /> :..........:..... <br /> r <br /> t 1 <br /> �: <br /> t.............:.......................'............._........ .. ... ... ... .. ... .. ... ... .. <br /> ..........,............_........... !............................ <br /> ; <br /> ............................:......... _ <br /> r <br /> ..._.._:_.... <br /> t <br /> .:AnJ Ju�i1iJ;IU <br /> s...�?I)$Li�.. <br /> n <br /> ENV :�� Tnt is��,i <br /> � T <br /> IR F4d <br /> , <br /> M I i <br /> ? i <br /> i <br /> i <br /> V: <br /> i <br /> ........................'.......... <br /> .'..... <br /> ........ <br /> � <br /> .............i.............�.... ... .. ... .. ... .. ... .. .. ... .. ... .... ... ... .. ... .... .. ... ... ... .- ... ... .. .. ... ... .. <br /> t a :. .......:........_.._...... ........... <br /> _ <br /> ............. <br /> `. <br /> ': <br /> .......:..... <br /> t <br /> t [ <br /> i <br /> : :. ` <br /> I <br /> 1 <br /> tt ... ... .. .. ... ... .... .. .. ... ... ._ .. .. ... ... ... ... ... ... ... .. <br /> 5 <br /> .......... <br /> 10 <br /> e i ' 1 i i i i i <br /> t i� <br /> r <br /> T i <br /> . <br /> ........................,........ :............»..............................._.....�_......:. , .....{,.r:._...wr.....fine....... ...-:t....�f-., .....f........ <br /> .......................................... .. ... ... .. ... .. ........................... <br /> : <br /> : <br /> - - - <br /> DEPARTMENT U E ON/,Y <br /> APPLICATION ACCEPTED BY: _DATE: V G_AREA //EMPLOYEE ID# DISTRICT OCCAiIION" <br /> Zo <br /> INSPECTED BY: �� DATE:��% PERMIT FIN YES DATE: %INSPECT / <br /> COMMENTS: <br /> PE CODE SC INFO AMOUNT CHECK ASH RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# SEPTIC ID# <br /> REMITTED BY <br /> 2-d 07 <br /> REVISED R-IS-01 <br />