Laserfiche WebLink
t <br /> LIQUID WAS PERMIT <br /> SAN JOAQU IN COUNTY PUaLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> li (f 304 E,WEBER AVE 7"'FLOOR,STOCKTON.CA 95202(209)468 3420 <br /> Y-' <br /> / NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM <br /> "DATE ISSUED <br /> JOB ADDRESS) / 6' (6 ILJ �c[l�f -, APN O�11J17OV� PARCEL SIZE: 15`a:_. <br /> CITVIZIP / BUILDINGPERMIT# <br /> oureh,GQ, <br /> I OWNER NAME ) jZ II ADDRESS : O W• I�.Gy�7[ ITF'4���i rC 1 5 <br /> CITYIZIP LQ (A 22 Y 0 PHONE NUMBER <br /> CONTRACTOR �.y: ,(� �����r.� l� G ADDRESS 7%X.� <br /> 1 � <br /> CITY(ZIP PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES K Y TOWNSHIP RANGE SECTION <br /> j TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION a RESIDENCE - NUMBER OF BEDROOMS: <br /> O-REPA[RIADD[TION 0 COMMERCIAL - - - <br /> 13 DESTRUCTION LI OTHER <br /> NUMBER OF EM PLOYEES: <br /> R ` R ENOINEEREpIALTERNAT.IVE , <br /> R CHARACTER OF SOIL TO DEPTH OF 3': GLS, PITISUMP SOIL CHARACTER: % /sss,� WATER TABLE DEPTH: <br /> ❑ PERCTESTI$) HOW MANY `/ APPLICATION <br /> ❑ SEPTIC,TANK TYPFJMFG ]6�yiJsycT CAPACITY H OF COMPARTMENTS <br /> ' ❑ GREASETRAP TYPEIMFG CAPACITY - III OFCOMPARTMENTS <br /> ❑ PKCTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION. PROPERTY LINE <br /> a <br /> ❑ LIFT STATION SIZE TYPE OF PUMP - - SAND OIL SEPARATOR(ENCLOSED SYSTEM) v <br /> F LEACH LINE #OF LINES' LENGTH OF LINES: "YC(/ pLg AyCp-O NEAxEAt: WELL­tSt) FOUNDATION PROPERTY LINE A�El7� C <br /> INFLITRATOR CHAMBERS: _ <br /> ❑ FILTER BED WIDTH _ LENGTH DEPTH DfST NCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> F ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> "1 <br /> ❑ SUMPS WIDTH LENGTH DEPTH bICTANCETO NCxRFST: WELL FOUNDATION PROPERTY LINE <br /> C <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DI.NTANCE TO NEAPEVT: WELL FOUNDAl'FON PROPERTY LINE c• <br /> SEEPAGE PITS # DlwMETER­ • DEPTH 19s_ DISTANCETO NEARS.r: WELL EOUNDATION__zJ,_-_ PROPERTY LINE <br /> I HERBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> ld AND RULES AND REGULATIONS OF SAN JOAQCIN COUNTY. <br /> i k MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE��CALL(209)468-3423_ <br /> S]GNED: <br /> TITLE: ff'+%'/�� a'�- DATE: G <br /> ' f I <br /> Rr- <br /> ---I-..�-i1--i moi- <br /> .1= --I -I-. <br /> �-�--- <br /> -- <br /> I T I I <br /> Rk , DEPARTMENT US.ON Y Jl <br /> I• APPLICATION ACCEPTE74 <br /> D BV: DATE; AREA MPLO/YES ID% V 4 _ ISTRIC! LOCATION I <br /> INSPECTEDB g� <br /> DAT PERMIT FIN YES DATE; `�� NSPECTOR: <br /> ' <br /> COM)JENTS.41//� <br /> F PECODE SCRiFO AMOUNT C.HEC !CASH V RECEIVED GATE PFRMITISERVICE REQUEST# WVOICE4 S_EPTICIDN <br /> REMITTED BY <br /> _` Z �� - cry a 003-� <br />