Laserfiche WebLink
i` LIQ. 1 WASTE PERMIT <br /> i . <br /> SAN JOAQUIN COUNTY PUB, ..EALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 309 E.WEBER AVE.,30.°FLOOR,STOCKTON,CA 95202 (209)468-34'20 2-4 "R N C. u^-F1 EF <br /> �1�ST.r AIEC] '4-! a f((;rt� - <br /> NOV-REFUNDABLI PERMIT EKP[R 1 YEAR FROM DATE ISSUE R E�..b+L)FI:S-FE <br /> 54 y-�•-r �� <br /> IOBADDRESS I r1 Wcs - <br /> CITY2IP I��r"'" 9 y�" PARCEL SIZFlAPN 1"�� + "-- <br /> r <br /> -t <br /> f OWNER NAh1E .`'Z Ct?.J 5%..2 u� ADDRESS !l f! I <br /> F �' fUh' / Z t� PHONE 5 <br /> CITYIZIP !A <br /> CONPRACTORRI�)� U. �t''/7 n•(o/'.f'¢'I���i .F- ADDRESS`7_ . <br /> CITYlZIP � Q57 57- C> PHONE 7�_'� '-./�•� / <br /> + i GEOGRAPHICAL INFORMATION'.COORDIANTES: 7{ Y TOWNSHIP-RANGE SECTION <br /> PERCTEST(S){ )HOW MANLY_ APPLICATIONt <br /> k r TYPE OF SEPTIC WORK: >� NEW INSTALLATION ❑ REPAIRIADDITION Cl DESTRUCTION �d 5� - <br /> ---M4 <br /> INSTALLATION WILL SERVE: .` RESIDENCE ❑COMNIERICIAL OTHERS 1 <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF I FEET:%r <4� PITfSUMF SOIL CHARACTER: WATER TABLE DEPTH, <br /> ❑SEPTIC TANKIGREASE TRAP - TYPElMFG CAPACITY NUMBER OF COMPARTMENTS_.� <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION - PROPERTY LINE1- <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ~ <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES ! - INFILTRATOR CHAMBERS �1 <br /> DISTANCE TO NEAREST' WELL FOUNDATION PROPERTY LINE <br /> `w. <br /> ❑FILTER BED WIDTH LENGTH DEPTH 41 <br /> - <br /> I DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> r\ <br /> ❑MOUNDED WIDTH LENGTH DEPTH -- <br /> DISTANCE TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ¢ 0 SEEPAGE PITS WIDTH LENGTH _-ti DEPTH <br /> ,4•� DISTANCE TO NEAREST, WELL FOUNDATION PROPERTY LINE- <br /> [3 SUmPS <br /> INE❑SUMPS WIDTH LENGTH -DEPTH <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> F_ <br /> 13 DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TON'EARF-ST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCE.S,STATE LAWS,AND RULE SA' ATIONS OF SAN JOAQUIN COUNTY. + - <br /> i SIGNED C� ���..-:.. ... - T11-LFCyq.l � /trt(P[�"t DATE { <br /> -.,. --- <br /> , „�` R I Ida <br /> &f ` r <br /> f r1trgk I T i `II I I y <br /> j <br /> QAd ' <br /> �•�, f k t C !F� i' a v� -t r <br /> P x <br /> "` <br /> a :.I <br /> II <br /> { 1 4 Std E <br /> 170!^ I�'rr. }'�` <br /> i �5 �[ _r� fJ *1� t �r <br /> r. `--}--• f"`^ f{mak" ,t `$d"y�"-�7 it '�£,�c'8•h <br /> .•'a01 <br /> �9{Ad ' P 1r[O ACEPTfD.EY r t t a^'!''" �' •C��� <br /> -•PLP OR9LMP•WSPECTED BY. DATE:. <br /> s3 } Y N <br /> r � 1N?1,151SPECTIONBY <br /> �i: PECODE SC AhSOOYT _ RECEIVED BY .DATE - PERMITISERVICE REQUEST M SEPTIC IIIA - <br /> 4 INFO REYIITTED <br /> i . <br />