Laserfiche WebLink
. r LIQUID WASTE PERMIT� .1 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE.,3R°FLOOR,STOCKTON,CA 95202 (209)468-3420 <br />• 'i <br /> t NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 1 i <br /> 10B ADD ESS <br /> 646 <br /> KOO <br /> CITY/ZIP D PARC L S[ZFJAPN © ~ <br /> OWNER NAM DDRESS <br /> CITY/ZIP QD E C14 r PHONE w` <br /> CONTRACTOR// �L�J Di t,N <br /> S�/'M I� l ADDRESS V� <br /> CITY/ZIIGCCA qszos PHONE 1 <f <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP_RANGE_____SECTION��IVSD <br /> PERCTEST(S) ( ) HOW MANY APPLICATION#: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ DESTRUCTION OCT 3 O LI1v� f <br /> INSTALLATION WILL Sl <br /> RVE: RESIDENCE ❑COMMERICIAL ❑OTHER N CdUNYY <br /> SAN <br /> NUMBER OF LIVING UNITS: �N :BEAR OF BEDROOMS: NUMBER OF E�MPLOYEES�t f.�R gL�C��TAL HEALRVI�CIv <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: /'"RV tki� 1LG0l�aw'R'�l PIT/SUMP SOIL CHARACTER:5W-bw �AT l RI'} AMIILE DEPTH <br /> SEPTIC TANK/GREASE TRAP TYPE/MFGC/ [1 CAPACITY NUMBER OF COMPARTMENTS <br /> �n 4 <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 1 E l/ INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ' I <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> I <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LIN � <br /> ❑SEEPAGE PITS WIDTH _ LENGTH DEPTH 15 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUNIPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE �! <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY TtL4T 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIA TES, D RL AND REGULATIONS OF SAN JOAQUIN COUNTY. ,. <br /> SIGNE TITLE:_ DATE: l� ✓� 1 <br /> G <br /> 64 <br /> ,I <br /> 1!V 46 5wG <br /> t <br /> I i <br /> I <br /> O � <br /> 4:r� <br /> .. FOR DEP MENT USE ONLY J_ <br /> Pt <br /> APPLICATION ACCEPTED BY: �� DATE: rte✓} <br /> A K,&OR SUMP INSPECTED BY: <br /> FINAL INSPECTION BY: "-'de <br /> COMMENTS: U ISd <br /> PE CODE SC AMOUNT 4 CHECK RECEIVED BY DATE PERMIT/SERVICE REQUEST# SEPTIC ID# <br /> INFO RFMITTEDI.1 ASH <br /> �I 3 61.q S- 02 <br /> A <br /> II <br />