SU0007046 - Laserfiche WebLink

Home Browse Search

LIQUID WASTE PERM'' %a*OAQUIN COUNTY PU)SLIC HEALTH SERVICES ENVIRONMEM%04HEALTH DIVISION 304 E.WEBER AVE 3"'FLOOR,STOCKTON,CA 95202(209)468-3420 fl ^+p ANON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Cx� JOBADDRESS �(O/�� V 1 I �I-�� ,� APN 145- 150 ✓ �1 9 PARCEL SIZE:9 9 CITY/ZIP H 1 f O o �{� BUILDING PERMIT N OWNER NAME R o i 9 c4K9,r ADDRESS �f (�ry 'r CITY/ZIP ! F P�I PHONE NUMBER 1 O�+�� CONTRACTOR ADDRESS CITY/ZIP PHONE NUMBER GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: ❑ NEW INSTALLATION x RESIDENCE NUMBER OF BEDROOMS: *J REPAIR/ADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: ❑ DESTRUCTION ❑ OTHER ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3% PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: ❑ PERC TEST(S) HOW MANY APPLICATION# QQ ❑ SEPTIC TANK TYPE/MFG_ CAPACITY #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS �^ ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) f LJLEACH LINE #OF LINES: LENGTH OF LINES: DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: Z ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ro ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS.-PLEASE CALL(209)468-3423 SIGNED: TITLE: DATE: .:......... ........ .,r_ f .........._�. _..{..___.......__...._. ... ...._ ...., .._.. 1 -..._ i _1 _ I ............ .._.. i ......: _. _..... ........... ...._............... _ 7 t -..._._ 1 _......._........... __........_............... ....... ----_..._--- _....._._..................$...................... ......_.. _......I - I - - - I _ ...... ....._._ T ..-i----L..._ ..._.._........._ _ ....__ _..._ C a-- ....... i ............_--� ....��. ............_.... - _.._.._�.. a I r- t- ! t--..._.. _ .-;-_._..... r--._............r....................... ......;... . __.;. . .. ..!_......._F..... t-- -- - 1 _.._:_.__................1...._.. .._..,_._._......_.._.:_....... _.._.._..{..._---...............�.......... _....._....._._........._.._......._._......�....__...... _ _ ._ .. ... i...... ._ ... .. ( .. f....�... ._..a.................._.. { 'lY T - ... _.t......... .._. ._..a...._ p c„� I j I , 000 . ............ ................................. I .. SAN I� r � O N rn DEPARTME(fNT USE ONLY G APPLICATION ACCEPTED BY: _DATE:q AREA�..I 8 EMPLOYEE ID# 131DISTRICT-�L LOCATION_q r INSPECTE�,B :_ _ DATE: O/k/.z. PERMIT FINAL❑ YES DATE: INSPECTOR: C MMENTS -a + �o PE CODE SC INFO AMOUNT CHECK#/CASH RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# SEPTIC IDN REMITTED BY REV SEDx-15-01