Laserfiche WebLink
J � <br /> LIQUID WASTE PERMIT <br /> SAN IOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISIOIQ d_ "r--1 <br /> 304 F.WEBER AVE,3"'FLOOR,STOCKTON.CA 952(12 (''09)468.3420 <br /> Fero-=c)u���r� - <br /> SIN•Rfbl'NDABLF PERY11'I'EXPIRES 1 YEAR FROM DATE ISSL"ED <br /> JOBADDRESS , I/Nt:r—fn-��-/3-1�1Af <br /> CITY/'ZIP _ <br /> IP C -11f c'�('�i ' _-- PARCEL S127JAPN I_!3 ~0 On 15 V'3T QcrP <br /> OWNER NAME 1 L� •I I __ _ —.UDRNSS LC__. <br /> CITI'(ZIP / _ PHONE _ <br /> CONTRACIUrf�,CR I_hl�j,`4n, D l7CA _ ADDRESS <br /> CITY'+21P c J4'Y1r.� L7-�J PHONE� <br /> OEOGRAPHICALINFORMATION COORDIANTFS: X__Y TOWNSHIP___RA.NGS_SECTION <br /> PERC IFST(S)( )HOW MANY APPLICATION r: PAYMEN I <br /> TYPE OF SEPTIC WORK: ❑ NEWINSTALIATION RFPAIRIADD1T10N ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OFLIVLVG UNITS:_ NUMBER OF BEDROOVIS--Z- NUMBER OF EMPLOYEESAN <br /> CHARACTER OF SOH.TO A DEPTH OF 3 FEET: PIT,!SVMP SOIL CIIARA(-IT.R: IIUU,�CCyH��pIS`�r�R S i <br /> J�SEPTICTANK'GREASETRAP TYPE•MFC P'k J, CAPACITY NUMBER OF �� <br /> �OMP7l'1LTMP.v"[S'4A i IUI4Fl- <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WF.IJ_ 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 PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPT"H <br /> DISTANCETO NEAREST:WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL _ FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH IENOTH DEPTH <br /> DISPAN'CETO NEAREST: WELL. FOUNDATION PROPERTYLINE <br /> ❑so-,Ips WIDTH LFNGTI I__ DEFPII_ <br /> DISTANCE TO NEAREST' WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAI.PONDS WIDTH Lr.NGTII DFmi <br /> DISTANCETONEAREST: WELL _ FOUNDATION —PROPERI"YLINE <br /> 1 HEREBY CERTIFY'PH.AT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCIS,STA l.A3YS•AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: _ _ ,�T1TLE:�1 uw.ulLi'y DATE: LS:��'�Lll i <br /> ,P' t�J <br /> Zc <br /> ITI <br /> l 11 <br /> - _ <br /> 1 <br /> ( 1 <br /> FOR <br /> DePARTMI:Nr USE ONLY <br /> APPllCATION ACCEPIEU BY:I DA <br /> 61151 WQl <br /> TANK.PIT OR SI:MP INSPE=rl Y_-. _J1A18_ <br /> FINAL INSPECTIOA8Y. !� T�e4I 1/��'�,�{,1/(L(�/��/712//J .••� /���"�� /' '� ry,_- <br /> COMMENTS: �,�L/'•�"9�FL�t'-� r" �Ur'-_6 loll -[it-a-i`c/J <br /> PECODE SC AMOUNT CHECK M) RE VEL)By DA )PERMI`TSEAVKE RF,QCEST# SEPTIC IDM <br /> IS PO REMII'I'FL) CASH f <br /> / 7 <br />