Laserfiche WebLink
LIQUID WASTE PERMIT _ _ (...''yyy'�., <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION (3EPTIV <br /> 304 E.WEBER AVE 3N'FLOOR,STOCKTON,CA 95202(209)469-3420 LJ(,+e�-" <br /> JOB ADDRESS F.2,2- 0-y�MARi;�qa S AFUNDABLE PERMIT EXAPPNE51 YEAR 1 - DATE OISSUED <br /> O 3 PARCEL SIZE: <br /> CITY/ZIP ��/^�� r If`�(U` BUILDING PERMIT#191 - <br /> l Op 11 RV Jr <br /> OWNER NAME 4 2 /)' /Y .(//�/� y-/�TG,�L/JaDRESS9 <br /> CITY/ZIP V \ �+ �r�� �i0"- PHONE NU�R�S <br /> CONTRACTOR Lt/ti A�' ADDRESS <br /> CITY/ZIP PHONE NUMBER <br /> V GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> r <br /> '�❑/j�EPAIR/ADDITION CI COMMERCIAL <br /> DESTRUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC TESTS) HOW MANY APPLICATION# <br /> r <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ` ❑ PKGTK PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: DI.WANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> INFLITRATOR CHAMBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DEMANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> r ❑ MOUNDED WIDTH LENGTH DEPTH_ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH DISPANCETON"RPO: WELL FOUNDATION PROPERTYLINE r <br /> r <br /> � ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH oLMANCE TONEAREM: WELL FOUNDATION PROPERTY LINE r <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DhTANCETONEARLM: WELL FOUNDATION PROPERTY LINE <br /> C' <br /> ►c 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE INACCORDANCE WITH SAN dOAQU1N COUNTY ORDINANCES.STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI Ii 1 1 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED: TITLE: DATE: J <br /> L <br /> I <br /> t T <br /> Irl <br /> �1T_���G. - <br /> I ---� --- - - - \ <br />