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SAN JOAQUIN OU LIQUID AWASTE LTH SERVICES LPERMIT NVIRONMENTAL HEALTH D294N ` <br /> 304 E.WEBER AVE.,3RD FLOOR,STOCKTON.CA 95202 (209)468-342 0 R C—C 2 U E_E = <br /> / <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED F�-'D F� +�r��\jy� <br /> JOB ADDRE,SSY / 7 CJlj(/ �(�L (N S R C^ i s t t O V S <br /> CITY, /ed leACiA // I /J'JrL�S PPARCEL SIIZF///APN l - - <br /> OWNER NAME // lh� /L JC• �C/C`f} ADDRESS � 3f ✓t/Ct*���i f ���� <br /> CITY/ZIP _ /!���C fl/Y S�?!s PHONE <br /> CONTRACTOR ADDRESS - -- <br /> CITYlZI P PHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIPRANGESECTION <br /> PERCTEST(S) ( ) HOW MANY APPLICATION N: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION DESTRUCTION N <br /> INSTALLATION WILL SERVE: ❑RESIDENCE e-imtOMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLET DEPTH <br /> ❑SEPTIC TANK/GREASETRAP TYPE/MFG CAPACITY t. 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 /> DISTANCE TO NEAREST: WELL FOUNDATION DROPERTY LINE <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 <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUMPS 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 /> 1 HEREBY CERTIF •THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANC' ULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �U�� �A�� �.' /� /J%, <br /> SIC TITL /!!� <br /> - Cil <br /> E <br /> 32 S <br /> ,it, <br /> �b <br /> SA SER CE <br /> N NT L H <br /> t <br /> VO I FI'ARTI11 N' 'E ONLY <br /> A (CATION ACCEPTED BY: _ DATE: <br /> 'TANK PIT,OR SUMP INSPECTS Y: ___ __ DATE: 1 `c <br /> FINAL INSPECTION BY: �/'� <br /> COMMENTS <br /> \:o - ^y _ -O ' L L/ O CyJ'1 1MA <br /> v <br /> PE CODE SC AMOUNT RECEIVED BN DATE PERMIT/SERVICE REQUEST N SEPT <br /> INFO Rt?M - CASH <br />