Laserfiche WebLink
LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ! -304 E.WEBER AVE.,3"FLOOR.STOC.KTON.CA 95202 (209)468-3420 <br /> I f��/�'J NON-RF,FUNDARLF.PERMIT EXPIRES 1 YEAR FROM DATE ISSUED I -" <br /> ` JOB ADDRESS `� 1 1 _- <br /> G <br /> CITYZP119 � G 11 LSTLE/APN69 T <br /> OWNER NAME RES° <br /> CITY/ZIP _ PHONE 3 <br /> CONTRACTORrJ ADDRESS <br /> ` CITYZP l'L 'c�at2� n zb j PHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIPRANGESECTION <br /> PERT TEST(S) ( )//ppOw MANY APPLICATION a: <br /> TYPE OF SEPTIC WORK: INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER^O__F__BEDROOMS>� NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOILTO A DEPTH OF 3 FEET: 'Ys'�1� PIT/SUMP SOIL CHARACTER:- WATER TABLE DEPTH_ <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MFG -li- - CAPACITY ZT UG' UMBER OFCOMPARTMENTS <br /> L <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL/y�J/�A,"� FOUNDATIONS PROPERTY LINE IX f2 <br /> (3 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> L ❑LEACHING LINE NUMBER&LENGTH OF LINES_�/ Lfe INFILTRATOR CHAMBER <br /> DISTANCE TO NEAREST: WELLICA FOUNDATION- ' PROPERTY LINES - <br /> Y ❑FILTER BED WIDTH LENGTH DEPTH <br /> ` DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> _ ❑MOUNDED WIDTH LENGTH DEPTH <br /> .I DISTANCE TO NEAREST: WELL e�T FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH ,3 f� LENGTH DEPTH ✓l ! T <br /> i CXR-f-F 1-42-L _3 f� <br /> DISTANCE TO NEAREST: WELL OUNOATIONPROPERTY LINE <br /> '61 ❑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 /> �a I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> _ . CCOUN0TY <br /> ORDIANCES,S[AT WS, ND RU D REGULATIONF SAN JOAQUIN COUNTY. <br /> TIRE: DATE)SIGNED: 5y <br /> a o <br /> IN I <br /> co <br /> y <br /> � c <br /> Q <br /> 6a <br /> YQ <br /> � r <br />