Laserfiche WebLink
( ` ' LIQUID WASTE PERMIT ' <br /> Q <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DlVIS10N <br /> 304 E.WEBER AVE.,3p0 FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESSia4G <br /> PARCEL SIZFlAPN <br /> CITYIZIP _ (� r/r h <br /> OWNER NAME GI� ADDRESS 6,`K7 (A),, v / iLc, <br /> CITYfLIP <br /> PHONE <br /> CONTRACTOR_ ADDRF',SS__..�.�_ r `� <br /> CITY/ZIP III IONE_ <br /> GEOGRAPHICAL INFOR ATION: COORDIANTES: X Y TOWNSHIP_RANGI3-SECTION <br /> P£RC TEST(S) ( HOW MANY_-3 _- APPLICATION#: ��v <br /> TYPE OF SEPTIC WORK: ❑ NEWINSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL 13 OTEIER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMIlFR 01:EMPLOYEES <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEP'T'H <br /> E7 SEPTIC TANK/GRFASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS N <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PRO <br /> ❑LIFT STATION SIZ£ TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES ! INFILTRATOR CHAMBERS <br /> \ <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY 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 /> r� <br /> DISTANCE*TO NEAREST: WELL FOUNDATION PROPERTYLINE <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> I <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE I <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIAN 'S ATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> S1GNEI <br /> TITLE: DATE: <br /> Llij <br /> V W <br /> ' � � Y J <br /> l $ <br /> ;.�.ii o <br /> ag <br /> rf v <br /> - ��J �A. Yn•�T�Ya ..yam—M.'M'.� - _ «�^'.'�.".}e%- �^ <br /> P'UK II@!'A141 N1 rd+ll wnvnLL <br /> APPLICATION ACCEPTED BY: DATE: <br /> i` TANK,PIT,OR SUMP INSPECTED BY: DATE:_ 7 <br /> FINAL INSPECTION BY: <br /> COMMENTS: <br /> PE CODG SC AMOUNT ((ACK! RECEIVED BY DATE: PERMITISERVECE REQUI•:5-r# SEPTIC lDp <br /> 'INFO REMITTED <br /> .2 <br />'I. <br />