Laserfiche WebLink
LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIV[SION +' <br /> 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> ` NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ]OD ADDRESS <br /> jqLCITY/ZIP a PARCEL SIZE/APN to.aq <br /> OWNER NAME DDRESS <br /> CITYPZIP Z-,:Ph� / PHONE <br /> CONTRACTOR�(�/C-�d i=/%/� �"dyl/���il� fr• e-'­le-,e ADDRESS <br /> Jr loo-r <br /> CITY/ZIP J PHONE_4:::?L7! <br /> GEOGRAPHICAL INFORMATION: COORDIANTE& x Y TOWNSHIP RANGE SECTION <br /> PERC TEST(S) ( ) HOW MANY APPLICATION#: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION REPAIRIADDITION C7 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE �❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UN[TS:--,/— NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: CF�/e--f PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Cl LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACHING LINE NUMBER&LENGTH OF LINES ! /d INFILTRATOR CHAMBERS l <br /> DISTANCE TO NEAREST: WELL AOV" FOUNDATION 10"�' PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTYLINE <br /> ❑MOUNDFD 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 /> III CERTIF HAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,S LAWS,AND RULES AY6 REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE: DATE: <br /> fit zf <br /> r \J <br /> � 1 <br /> i <br /> 1 iv i <br /> FOR DEPARTMENT USE ONLY QOOJ <br /> APPLICATION ACCEPTED BY [ ATE: 1 <br /> TANK,PIT,OR SUMP INSPECTED DATE: <br /> FINAL INSPECTION BY: <br /> COMMENTS irif AfALv <br /> PE CODE SC AMOUNT CHECK RECEIVED BY DATE PERMIT/SERVICE REQUEST# SEPTIC ID# <br /> INFO REMITTED CASH <br />