Laserfiche WebLink
LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNT} PUBLIC HEALTH SER\'ICES ENVIRONMENTAL HEALTH DIVISION <br /> 704 E.WEBER AN E..3-"FLOOR.STOCKTON.CA 9570'_ UIN)468-34200 <br /> NON-R'F'UND.{pLE PER\II F.X IRFS t YEAR FROM DATE ISSUED <br /> JOB ADDRESS /7260 E1 Libcrlby l? <br /> CTfY/ZIP_ ; 1 1 �) PARCEL SIZEIAPN U �/I '�.�0 C _1 I'T - GLS J <br /> OWNER NAME r��SCO I` LWnQ M7}Ml ADDRESS �J 3 0 "K�` I levy- my . <br /> CITY/ZIP L EscJ�+4. gsa 4�o PHONE <br /> CONTRACTOR ADDRESS <br /> CITY/ZIP PHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP RANGE_SECTION <br /> (V` <br /> PERCTEST(S) ( HOW MANY APPLICATION M: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES <br /> CHARACTER OF SOIL TO A DEPT OF I FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> ❑SEPTIC TANK/GREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS (� <br /> DISTANCETO NEAREST: WELL FOUNDATION -ROPERTY LINE 4 <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 PROPERTY LINE PAYivi�I, , <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH ,�ECEN E;_-, - <br /> DISTANCE TONEAREST: WELL FOUNDATION PROPERTYLINE <br /> ❑SUMPS WIDTH LENGTH DEPTH APR <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE SAN JOAQUIN w <br /> CUUiv I <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH `NNPUBLIC HETAL ALTH SERVICE <br /> UIV;I,; <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STAT LAWS,AN LESA REGULAT NS OF SAN JOAQUIN COUNTY. <br /> SIGNED: _ _ , TITLE: C%VLL._ OILS DATE: <br /> L"Jl�l'7 •OAO <br /> I I • TEs r� ...�o� I �C� sl �� <br /> IlI I� <br /> `.�`P� <br /> I lr I N %% I I <br /> 1 PARCIEL <br /> I I w AGES same <br /> I�ll I <br /> I PARCEL 9 <br /> G AaAES egpg5 <br /> PARLEL 1 <br /> 4�ALa@e <br /> l "7 I I <br /> N i <br />