Laserfiche WebLink
i <br /> x LIQUID WAST <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES .:rIRONMENTAL HEALTH DIVISI�4 H R N C)-Fl Ci <br /> i s 304 E WEBER AVE_,31O FLOOR,STOCKTON,CA 95202 (209)468-3420 n EC?U ESTS <br /> NON-REFUNDABLE PERMIM EXPIRES 1 YEAR F M DATE ISSUED h F���rALL <br /> r 1 V 4�� <br /> JOB ADDRESS Q <br /> C1TY2IP R,, _ n PARCEL SIZEIAPNQ_i�I o <br /> OWNER NAME C4 /LFI1'L� �LC ADDRESS <br /> CITYfZIP PHONE .�77 <br /> CONTRACTOR � ADDRESS T <br /> CITYmp PHONE 3 <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIP_RANGE_SECTION <br /> AAA,. PERC TEST(S)( )HOW MANY APPLICAT10Nf1: <br /> !•'�' TYPE OF SEPTIC WORK: EW INSTALLATION ❑ REPAUVADDITION [3DESTRUCTION <br /> - INSTALLATION WILL SERVE: Ip:CE ❑COMMERICIAL Q OTHER <br /> _ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:__,_C� NUMBER OF EMPLOYEES: <br /> 1 <br /> ' C RACTER OF SOIL TOA DEPTH OF 3 FEET:64ra 'L� P[TISUMP SOIL CHARACTER'L� WATER TABLE DEP e!�n <br /> { S IC TANKIGREASE TRAP TYPFIMFG Z.C��3 F .[, CAPACITY t2�0 NUMBER OF COMPARTMENTS S_ <br /> ❑PKC TREATMENT PLANT DISTANCETO NEAREST: WELLLOP r`+ FOUNDATION IV PROPERTY LINES_,_— <br /> "- ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r <br /> LINE NUMBER&LENGTH OF LINES e9 d' �(/�G� INFILTRATOR CHAMBERS <br /> i DISTANCE TO NEAREST: WELL FOUNDATION lb / PROPERTY LINE So <br /> _ ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYLINE <br /> —CIE PITS WIDTH c& LENGTH DEPTH � -1;1--) <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 11 DISPOSAL PONDS WIDTH LENGTH DEFIH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> F. 1 HER RTI V THAT I NAV P �REGULAT�IONSOFSA�N <br /> ND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> Op <br /> NCES, T E L W5,A ANJOAQUIN COUNTY- {�J <br /> -- S]G EA: TT <br /> ,^I' � DATE. Z <br /> i <br /> 0I e­ <br /> is <br /> r � <br /> I <br /> In A. <br /> Dell <br /> / <br /> { <br /> N <br /> Will it <br /> p E O• 7 DI' SID It <br /> i E ARTME,YT 5 LY <br /> APPLICATION ACCEPTED DATE= <br /> TANK,PTT,OB SUMP INSPECTED BY: DATE._ <br /> j f ! FINAL INSPECDON BY: (� _ <br /> I� COMMENTS: -/-" <br /> lPECODE SC AMOUNT CHECK RECEIVEDBY DATE PERMIT/SERVICEREQUE5TO SEPTIC B]# <br /> S INFO REMI N <br /> aye/ a3 �ZS" <br /> I <br />