Laserfiche WebLink
1_ <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> IME.WEBER AVE,.3'FLOOR,STOCKTON.CA 95202 009)46934W <br /> NON.REFI ND B PE T XP I V FRO' A 24 H R N(DTI C <br /> JOB ADDRESS 1. . !n / RECIUESTE_L <br /> GTTYZP (((il!�( ��.I�� 1 I //''''� PARCEL S1 APN �.1 7 <br /> OWNER NAMB.�= =T"/'- �n �1 �'A �- DRESS <br /> Cmw {' I/cz <br /> CONTRACTOR IL, I-t ( ) j <br /> ADDRESSd >'! V,P <br /> 1') PHONE;) !1 ",Z <br /> Rr• GEOORAPHICALINFORMATION:COOROIANTES: X_Y_TOWNSHIP_RANGE_SECI20N_ <br /> PERCTFST(S)(-/HOW MANY_ APPLICATIONT. LA L&L- 'j y <br /> TYPEOFSEPIICWORK: ❑ NEWINSTALLKDON ❑ REPAIRfADDMON ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 13 RESIDENCE ❑COMMERICIAL ❑OTHER w <br /> Ir INSTALLATION <br /> NUMBEROPBEDROOMS: <br /> NUMBER OF EMPLOYEES._ <br /> CHARACTER OF SOLL TO A DEPTH OF J FEET: PITISUMPSOILCHARACTER: WATER TABLE DEPTH <br /> ❑SEPOC TANK/GREASETRAP TVPFJMFO CAPACITY NUMBER OPCOMPARTMENT$ <br /> ` ❑PKG TREATMENT PLANT DISTANCETONEAREST: WELL_ FOUNDATION <br /> PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF❑NE / INFILTRATOR CHAMBERS <br /> BBB DISTANCETONEARESI': WELL FOUNDATION PROPERTYLINE <br /> ❑FllT£R BPD WIDTH LRNGTH DIiPIH <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAC£PITS WIDTH LENGTH DEPTH <br /> DISTANCETONEAREST: WELL FOUNDATION PROPFRTY LINE <br /> 13 SUMPS WIDTH LENGTH <br /> DEPTH <br /> DISTANCETONEAREST: WELL FOUNDATION PROPEFTYLINE <br /> ❑DISPOSAL PONOS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL _FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK W WL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> S,� <br /> ORDIANCE/SPA-Bf W WSLAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> TSE: Of'I( (�f` -DATE, I- <br /> V <br /> E <br /> 6. K <br /> „r- <br /> LJ SE C S <br /> L. <br /> i <br /> f <br /> �1 { <br /> y C' <br /> 0 <br /> 1 , <br /> J / ( Po0.DRPARTMFM ME ONLY t <br /> APPIJUTION ACCEIT®BY:_ i(�? $ •Y'•F.y�.�^- //l <br /> DA E / L <br /> IANR,pR,p0.5UMP INSPECIFD BY: <br /> ._ <br /> FINAL IN9PEC110H BY: GATE' <br /> COMMFMS: <br /> PE CODE SC AMOUNT {IL&_y(N_ RECEIVED BY DA1£ PBRMR/SPRVICEREQDBSTp <br /> INPo ITTPD 'BB` BPPTICIM <br /> V <br />