Laserfiche WebLink
�/ LIQUID WASTE PERMIT�J <br /> SAN IOAQUTN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL7IF.ALTH DIVisIOVj4 HR NOT 1 C <br /> " � '� 304E,WEBER AVE., FLOOR,STOCKTON.CA 95204 (209)468-3420 REQUESTED <br /> N EXPIRES 1 YEAR FROM DATE ISSUED FOR ALL <br /> JOB ADDRESSII�ICPFC-`TIC79V <br /> cITYZP 1 ,(' OA(� )J3-7 6 /PARCELSIZFIAPN ave'--•a-4 o - ay <br /> OWNER NAME / AI'P.^NS I�Jj�fVCtC-W I ADDRESS 1 <br /> 7700 �/YJ ` �•`� �C�?p'=� . <br /> CITYZP- l.-� ^/'t �3� , _ e PHONE ��/Jo� —/�-3�n� �t � <br /> CONTRACT 7n'� - +-f_IO'(ynR-� Irvqc�%IlA� ADDRESS IvO C7Y��9/4 • S'�, � �D <br /> cITYZP oo"k .�Q � JT�(� PHONE SIU - ,4-lft — . DQ0 <br /> GEOGRAPHICALINFORMATION: COORDIAMI'F_S: X_ Y_TOWNSHIP_RANGE_SECf10N_Cy <br /> I'IiRI"1'IiS'I'ISI Hi!IIIIW MANY� ��// � <br /> 'I'YPI:(W S0111C WORK: ❑ NEWINSTALLATION G�RREPAIR/AUDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE @'COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS:_ NUMBER OFEMPLOYEES:_ <br /> CIIARAC1ER 01:SOIL TO A DEPTH OF 3 FEET: C11 C PIT/SII MP SOIL CH ARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPPIMFG CAPACITY NUMBER OFCOMPARTMENTS <br /> ❑PRO TREATMENT PLANT DISTANCETONEAREST: WELL_ FOUNDATION PROPERTY LINE�,(MENT <br /> ❑LIFT STATION SIZE TYPEOFPUMP SAND OSI.SEPARATOR(ENCLOSED SYSTEM) RECEIVED <br /> ❑LEACHING LINE NUMBPR h LENGTH OF IJNE!S / INFILTRATOR CHAMBERS �(� 2000 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE AUG <br /> ❑FILTER BFJS WIDTH LENGTH DEPTH SAN g�J�OAOUIN COUNTY <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTY LINE EN CES <br /> ppNN1ENTA1IN AITNDIVI DN <br /> ❑MOUNDED WIDTTI 111 DEPTH <br /> DISTANCETO NEARGS'1': WELL FOUNDATION PROPERTY UNE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSALPONDS WIDTH LENGTH DEPTH <br /> DISTANCETONEARFST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREP ED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCF/"TTAATTE LAWS, <br /> AANQ_RUL DKEGULA1T OJp'S OF SAN JOAQUIN COUNTY. L J ./ <br /> SIGNED: (L'���I` !"✓/•'2 ( �Ir'T TITLE:-11"V Ge �(/IQsMij Q.� DATE L7 O d <br /> I� Zg1h' pj.`f v g t(( I T. <br /> 1. <br /> ...2 <br /> I "`R bEPA TME ll t(NVLI" <br /> APPUCAPION ACCEPTED BY: �^ DATE: <br /> TANK,I'TI'.f1N%)IMP INS14:t-i E:D III'- _ _/_ _ _ _ _ _ __ _ ___ _ _DA•I,B, �dV <br /> IINALINNIYA-ruA I � <br /> COM�M,EyNTyS:_._[ T/ LVVVr•"r-3W!�!� /:°t'L"1,/r1 A-01c a&-k W// e Iy Tlenj /n rALbwe err ,? <br /> DECODE K AMOUNTCHEC RECEIVEDBV DATE PERMIT/SERVICE REQUESTS SEPTIC IM <br /> INPD ReMTI'IF.D ASI) <br /> 1 Y <br />