Laserfiche WebLink
1: 30 LIQUID WASTE PERP T <br /> `0 JOAQUIN COUNTY PU)ALIC HEALTH SERVICES ENVIRONMh%.0(L HEALTH DIVISION <br /> 306 E.WEBER AVE 3R'FLOOR,STOCKTON,CA 95202(209)468-3620 <br /> N N-REFUNDABLE PERMIT EXPIRES 1 YEAR 1/F�ROMM DATE ISSUED <br /> JOBADD[R`EES.S10100 N LOWrZjZ &ieUHRS= N O'�A-O?a VI PARCEL SIZE: <br /> CITY/ZIPS 1 `// /��'y��r /� �•c BUILDING PERMIT#Af c �// �� ��r/�,��/� c <br /> OWNERNAME Y/F�Y/'-� /�I 1 /C.15205 <br /> /���[�Y�nA/i ArT6 J ADDRESAJI- ^+I/.Yya- J/e ISS QP`r�Vp��la�,l/y��t(.�� IT <br /> CITY/ZIP�IJU�/I�`) O` v / 205 PHONE NUMBER <br /> ��U'G1ISI '(c�LlllT✓ ��I'RA bo) <br /> CONTRACTOR /.-A' ) S �VIr� ADDRESS �I JI A/ Nr �II�U� ryn7 <br /> CITY/ZIP V 1 (/CX�1 D` • PHONE NUMBER <br /> 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 /> yREPAIR/ADDITION )e COMMERCIAL <br /> Ll DESTRUCTION El OTHER <br /> NUMBER OF EMPLOYEES: 'n <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': G�PIT/SUMP SOIL CHARACTER: GlAV WATER TABLE DEPTH:-40f'— <br /> Ll <br /> EPTH: t'❑ PERC TEST(s) HOW MANY APPLICATION# <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP A/r) SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I� LEACH LINE #OF LINES: LENGTHOFLINES:7V DISTANCE TO NEAREST: WELL�I FOUNDATION50+ PROPERTY LINE_ S <br /> INFLITRATOR CHAMBERS: S <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DISTANCETONEARE.I: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH_ PISTANCETONEAREST: WELL_ FOUNDATION PROPERTY LINE <br /> s <br /> ❑ SUMPS WIDTH LENGTH DEPTH DI6TANC[TONEAREAT: WELL FOUNDATION PROPERTY LINE r <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH_ DISTANCE TO NEAREST; WELL_ FOUNDATION PROPERTY LINE �` <br /> SEEPAGE PITS # DIAMETERII DEPTH DISTANCETONEARESr: WEL4601 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 ORDINANCES,STATE LAWS <br /> N <br /> MIN U 2 HOUR AD ACB NOTICE REQUIRED FOR INSPECTIONST <br /> LASE CA (209)468-3423 2 <br /> SIGNED: [x— t� TITLE DATE: ylO ► <br /> v <br /> 4 <br /> z >_ --- <br /> � <br /> I <br /> £ o—o--- •� _ �. �.. f444 T � LLL <br /> _ t - <br /> yyyPNNN <br /> Nlt 1 .. <br /> a I <br /> ...... i 4 <br /> I I I <br /> DEPARTMENT VSFO LV (NV6tUNME - <br /> APPLICATION ACCEPTED Y: DATE: .S1� EA_i L�EMPLOYEEID# DISTRICT OCATION <br /> INSPECTEDBY: DATE: V / If�� <br /> ' "e PERMIT FINAL YES DATE: S-1 C L-NSPECTOR: <br /> COMMENTS: <br /> PE CODE SCINFO AMOUNT CHECK ASH RECEIVED DATE PERM ITISERVICE REQUEST# INVOICE# SEPTIC IM <br /> REMITTED BY <br /> `iZl " 2S 5 ISI `� 0 0 Z- <br /> REVISED IFISEI <br />