Laserfiche WebLink
LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBER AVE.,30..FLOOR,STOCKTON.CA 95202 (209)468-3420IIII <br /> NON-REFUNDABLE PERMIT EXPIRES i YEAR FROM DATE ISSUED � # i <br /> JOB ADDRESS O •777000 <br /> l <br /> CI,LYrGiP c PARCEL SIZF/APN <br /> OWNER NAME yS A � ,A/dS• vha CAADDRESS D G✓t'r^� <br /> l^ <br /> CITY/ZIP /�/� ��� / PHONE / �r <br /> CONTRACTOR�/T/J1� Pp/..` SFAS{°'y_ADDRESS ��lUy / �/'•a�✓• •�"� `��_ <br /> CTI'Y2IP /�^�t� � '� PHONE ,..�7-r"y �"•� r <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X._, Y_TOWNSHIPRANGE_SECTION <br /> PERCTEST(S) ( ) HOWMANY APPLICATION B: <br /> TYPE OF SEPTIC WORK: R NEW INSTALLATION ❑ REPAIRIADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE I&COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OPBEDROOMS:_ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> ❑SEPTIC TANK/GREASE TRAP TYPPIMFC /Z CAPACITY ^/6Lk NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL ?m FOUNDATION Z,sy PROPERTY LINE,y=_ <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINFS / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> Ztel DISTANCE TO NEST: WELL FOUNDATION: PROPERTY LINE <br /> III MOUNDED 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 /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE 3NORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE/�L/EN'S,AND RULES AND REGU JOAQUIN COUNTY. <br /> SIGNED: /! TITLE: OCJ DATE: �2 <br /> r - h <br /> V <br /> J <br /> UF <br /> ro <br /> UUC LA.0 j — <br /> FORDEPARTMENTUSE ECEIVED l7d <br /> APPLICATION ACCEPTED BY: DATE <br /> TANK.PIT.ORSUMPINSPE BY DATE <br /> FINAL INSWON BY: /- <br /> CommENTS: S IIM14 /_ t'Z.'R�+ 3 �A!W I ! NDnr`� 'r — ROCK G N O6R I f�15 <br /> 1 1 I / IN St ERVW I-Y.&/ Q !F! <br /> PE CODE SC AM MC XI RECEIVED BY DATE PERMIT/SERV UEST♦ SEPTIC IDX <br /> INFO REM <br /> H1 14 050 5/Y I -Zo&- 1310 7S <br />