Laserfiche WebLink
LIQUID WASTE PERMIT <br /> 10 SAN 3OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3MO FLOOR,STOCKTON.CA 95202(209)468-3420 <br /> /' '^/,JJ1fQN-REFUNDABLF PERMIT EXPIRES 1[YYEAR FROM DATE ISSUED 7g <br /> JORADDRESS )-Q QG66 �'/►•��/��{, \jam', ` 6 W APN l.� CI�/ 7� PARCELSIZE: ` FJ <br /> CITY/ZIP l_"�r oy,/ `o 2��/ � eBUILDING PEAMFiM (�� ��-'�- <br /> OWNER NAME�EC 271A$w.[�ni. rc'/h vQ' --, \6q � ST 2r au <br /> /� A DRESS <br /> CITY/ZIP `file l A <br /> ` PHONE NUMBER <br /> CONTRACTOR .'.leel l �, SI71/��" �� ADDRESS CIV y1J'I ` �1 <br /> CITYAJP t�u PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION:COORDINATES'X _..__Y _ TOWNSHIP RANGE SECTION <br /> TV PE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ REPAIK/ADDITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION (J OTHER <br /> NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> * PERCTEST is) HOW MANY f APPLICATION#_ <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE .V <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) _1^ <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LINES: WSTANCE TO NEAR-T: WELL FOUNDATION PROPERTY LINE \ <br /> IN FLIT RATOR CHAMBERS. m <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DI.TANCETONEARLST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIWANCETONEAREST: WELL FOUNDATION PROPERTY LINE J <br /> ❑ SUMPS WIDTH LENGTH DEPTH DLWANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DLSLANCETONEARE.T: WELL FOUNDATION PROPERTY LINE ( — <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEAR-T: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> lnK�/ MINIMUM 24HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 <br /> SIGNED:_�AI 14d 04 .Y�IV 4OrtTITt� �. TITLE: JC A r DATE:, <br /> .1 - <br /> 11 <br /> I <br /> _ <br /> pp� <br /> DF.PARTME EO/LY <br /> APPLICATION ACCEPT D BV: E DATE:r'^y/�.•../ EA EMPLOYEE I/D/M/—/` Y�DISTRICTLOCATION C^ <br /> INSPECTED BY: C DATE: a/ PERMIT PINA YES DATEt� INSPECTOR: <br /> COMMENTS. <br /> PE CODE SC INFO AMOUNT CHEC ASH RECEIVED DATE re INVOICE$ SEPTIC ID. <br /> REMITTED RY <br /> zzz �9 1150 9/too S/Z�'3// 7� <br />