Laserfiche WebLink
rLIQUID WASTE PERU ' J <br /> �{ (. IJOAQUIN COUNTY PU)3LIC HEALTH SERVICES ENVIRONME. HEALTH DIVISION <br /> a. _ 4`i 304 E.WEBER AVE 3"1'FLOOR,STOCKTON,CA 95202(Ib;,,,46R-3420 <br /> 3 �+fNON-RE UNI)ABLF PERMIT EXPIRES 1 YEAR FROM DATE ADDRESS DATF,ISSUED <br /> J� <br /> APN I © PARCEL SIZE: ? <br /> J <br /> ^,y ! BUILDING PERMIT# <br /> ZIP <br /> OWNER NAMF e� for tr ADDRESS <br /> CETI'IZIP PHONE NUMBER 1����..,� ) I / <br /> CONTRACTOR /C C �q 9r.0 d ADDRESS C "NLi�r �-C Jn <br /> CITY/ZIP .r„J� y7�'•f �3 <br /> YIfONF. NUMBER <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y <br /> TOWNSHIP-RANGE-SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE; NUMBER OF LIVING UNITS. <br /> ❑ NE ® RESIDENCE <br /> L} R PAIIWAADDITIlON ' y��.f// �,��f� NUMBER OF BEDROOMS: <br /> ❑ COMMERCIAL <br /> D RUCTION ❑ OTHER NUMBER OF EMPLOYEES: <br /> ❑ ENGINE£RED/ALTERNATIVE- <br /> CHARACTER OF SOIL TO DEPTH OF 31: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERCTEST(S) HOW MANY APPLICATION# <br /> SEPTIC TANK TYPE/MFG�f C cy /� CAPACIT� #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCE TO NEAREST; WELL Ci FOUNDATION 4 CD <br /> �t.� PROPERTY LINE �_ , <br /> ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 41 LEACH LINE #OF LINES: LENGTH OF LINES: -* STANCE TO NEAREST: WELL 0 FOUNDATIONO PROPERTY LINE_ <br /> INFLITRATOR <br /> C!;;MBERS: <br /> ❑ FILTER BED WIDTH LENGTH DEPTH DIRTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WIDTH LENGTH DEPTH D15TANCETONEAREST; WELL FOUNDATION PROPERTY LINE <br /> r <br /> SUMPS WIDTH .-4F.NGTIi_. '_- oISTA7kC$TONEAREST: - - -- A'I'{ON:.../�”) PROPERTY LINE _ rp <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCE TO NEAR EST: WELL FOUNDATION PROPERTY LINE � <br /> O . <br /> 1 HEREBY CERTIFYTHAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS N <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. l� <br /> � Y <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)468-3423 <br /> SIGNED: — TITLE: =�i �^ DATE: <br /> . <br /> t E <br /> I i <br /> e .. <br /> I <br /> .. S.3 .. .... � � � <br /> .... <br /> .....- <br /> 1 . <br /> . : .... } <br /> Fav E <br /> r <br /> r�E� 81 �I,- <br /> . <br /> �: r s�' <br /> : <br /> S�A+NpIJOA�4+ UIN CC15.��NT 1. <br /> PLI6UC HfACT�f 4�r,V[["�S <br /> NO.GNME.I�.TF�t.. fui,F ll, <br /> I <br /> _ _ <br /> __ <br /> --- —;�: <br /> APPLICATION ACCEPTS BY: _ DATE: 'EA EMPLOYEE ID# DISTRIC'M5LOCATION l / <br /> C. <br /> INSPECTED BY: �- _ DATE": d�PERMIT FINAL YES DATElmil /INSPECTOR: I <br /> 1 <br /> COMMENTS- E. QS"}•'t.•w�( h l` <br /> - ��._-� .--"�-O�L� ,..�•,w?G ""���ST <br /> PE CODE SC INFO AMOUNT CHECKNI SH RECEIVED DATE PERMITISERVICF.REQUESTN INVOICEN SEPTIC IDN <br /> REMIT"FED BY <br /> REVISED N-IS-OI <br /> r <br />