Laserfiche WebLink
, LIQUID WASTE PERMIT' *i "" <br /> r •QUIN COUNTY PUjBLIC HEALTH SERVICES ENVIRONM e I <br /> ENTA DIVIS.ON <br /> 1 301 E.WEBER AVE 3" FLOOR,STOCKTON,CA 951021209,-..a L <br /> NO\-REFUNDABI,F.PFK T EXPIRES I YEAR FROM DATE ISMIE <br /> � � <br /> JOB AdDkF_k4 '/yy/ <br /> Z v' APR O PARCEL SIZE: <br /> CITVIZIP_ BUH DIES <br /> NG PERMIT rr <br /> �n C�Ra D , <br /> CITI/ZIP �} PHONE NUMBER <br /> CONTRACTOR l ADDRESS <br /> CITY/ZIP PHONE NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: N <br /> Q <br /> REPAIR/ADDITION \Lr'jCOMMERCIAL <br /> / NUMBER OF EMPLOYEES: <br /> CIDESTRUCTION:: _ ❑ OTHER <br /> L3 . ENGINEEREDIALTERNATIVE <br /> CHARACTER OF SOIL TODEPTHOF 3' zQi PITISUMP SOIL CHARACTER:�r�.z� eL,4 WATERTABLEDEPTH:/&2� <br /> 1�` z <br /> C7 PERCTEST(S) HOW MANY APPLICATION#_ Z ' 2 3- <br /> SEPTIC TANK TYPE/MFG(_ `�' CAPACITY � 60(9 NOF COMPARTMENTS � 0 <br /> /❑ GREASE TRAP TYPEIMFG CAPACITY a OF COMPARTMENTS N <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIF STATION SIZE TYPeoF ruMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r 1 0 <br /> 1 X LEACH LINE OF LINES:-3--LENGTH OF LINES: //� E-� 4 <br /> DISTANCETONEAREST: WELI � r FOUNDATION PROPERTY LIN ?INFLITRATOR CHAMBERS: �70i <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DIRTANCETONEAREST: WELL FOUNDATION PROPERTY LINE v <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DiRTANCETONEARFAT: WELL FOUNDATION PROPERTY LINE <br /> ���....,///w <br /> qWl SUMPS WIDTH ` I.SNOTii_ - DEPTH RIRTANCHTONEARF.FT: WEL V POUNpATION�f.PROPER7YLINE <br /> /❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DIRTANCETONEAREST: WELL FOUNDATION PROPERTY LINE - <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DIRTANCE TO NEAREST! WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIPYTRA E PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> e AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 7 <br /> MIN MUM 24 H ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 L� <br /> SIGNED: / TITLE: DATE: <br /> --....- --............----- -.....--............._.... <br /> ...................... <br /> ti ._-_-.-.__-.-.-_.-�_-.-_•.-.Y-......_.µ..__...-,_..-.....-..•..-....., ...._.... <br /> ......... .. ,,......,... .... ...... ? _. ................ <br /> .,.... <br /> ._...._.._._.__........... <br /> ......... <br /> .....................-- ...... <br /> .._. ..._.-..__. _...................... .._............. <br /> _ ._.._._. . <br /> f/ <br /> --........ .................... .......•. ..•.....................•........... . ........ <br /> _..._. ......- <br /> ..._...._....-..-__..... <br /> -- -- ---._:.....--........... _.... ............ _..._........ .....-............__ .. .. .................. <br /> .. ... ........ . <br /> _........................... ------....... _.... ..._ ....... - <br /> — — -- -..._ _. _.-._.__ ....._.. _....__.. ....... .-.....•. - - _ <br /> _ _ - ........... <br /> - >< __ _- -_.. ___..._-.. _........._..._................................................................ ................ ........... <br /> . ..........-. .R.. ..,..- .._,V ZE....... .......-_...... <br /> ............................_ _. <br /> ... _.................. .... .. .......,,........ ........._,...., <br /> do <br /> uH <br /> E LTH <br /> .... ._ r - <br /> _ —.-_ _ -.......-. _.. . .....--_......_................ ...._...._............. ._......._._...,...... _ <br /> Mt <br /> SaoT 10 ' <br /> �--1 <br /> DF.PARTME+N+nnT USE ONLY <br /> e APPLICATION ACCE DATE F V"ll �" AREA EMPLOYEE10# DISTRICT IpCATIflN� <br /> INSPECTED DATE: 10131-12- PERMIT F[NALA YES DATE: /C� �3 INSPECTOR: <br /> COMMENTS/0'2Z v2- No ICaa;I+,Sy'a< yaT - ACHr tIUL"S NSD Z��/Hn2E RoC' /4� DTi`/�13Glri' 7 Z�� <br /> PECODE SC INFO AMOUNT L CHECKN ASH RECEIVED DATE y�PE/R�MIITTISERVICE REQUESTN INVOICEN SEPTIC IDN <br /> Y-21 fo JP 2,0 00 <br /> REVJSED N•IL/l <br />