Laserfiche WebLink
LIQUID WASTE PERMIT <br /> SAN JOAQI, Jl1N'I'1'PUBLIC IIIiAI;I'll SERVICES ENVIRONMENTAL 11 <br /> DTVI.ION <br /> 304 E.WEBER AVE.,3RD FLOOR,SfOCKTON,CA 95202 (209)468-3420 <br /> • <br /> /� �] r n ON-REFUUNDABLE,P�RMIT EXPIRES II YEAR F 111 DATE ISSUED <br /> JOB ADDRESS l V�IJ,Q/��" AIC- <br /> JL <br /> CI'TY/ZIP L wo / / PARCEL S'IZE/APN <br /> E � e- ''L <br /> OWNER NAMW IF144� N ADDRESS <br /> CITY/ZIP /� PHONE / <br /> CONTRACTOR --� `0�Jrj:r4) J � ADDRESS/� u <br /> CITY/ZIP��/ Leff l 7 le/� 7 PHONE_ 3 <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP RANGE SECTION <br /> PERC TEST(S) ( ) HOW MANY APPLICATION#: <br /> TYPE OFSEPTIC WORK: ❑ NEW INSTALLATION 'AIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: �IDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:---/ nnNLIM13EER��O,,F BEDROOMS NUMBER OF EMPLOYEES: /I� <br /> CHARACTER OF SOIL TOADEPTH OF3FEET f�O�D�lX PIT/SUMP SOIL <br /> ��C77HAARACTE WATER TABLE- <br /> DD�EPTW'y <br /> PTIC TANK/GREASE TRAP TYPE/MFG G C� CAPACITY/0 NUMBER NUMBER OF COMPARTMENTS .1Z <br /> r / <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL* FOUNDATION/5 PROPERTY LINE O _ <br /> ❑LIFTSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) r <br /> EACHING LINE NUMBER&LENGTH OF LINES c2tl Q i� r-5 INFILTRATOR CHAMBERS i <br /> DISTANCE TO NEAREST: WELL. FOUNDATION PROPERTY LINE ©d / C3 <br /> ❑FILTER BED WIDTH LENGTH DEPTII <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE c < <br /> r <br /> S, PAGE PITS WIDTH 3 LENGTH DEPTH 1: a <br /> DISTANCE TO NEAREST: WELL�� f T FOUNDATION ( PROPERTY LINE (96 / <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 /> I HEREBOE-S,ST <br /> Y I T 11 REPA iE WORK WILL BE DON'IN ACCORDANCE WITH SAN JOAQUIN COU TY <br /> ORDIANTF L W' S ND REG ATION' F SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE: n� DATE e� <br /> I <br /> ol <br /> vv <br /> 1 <br /> l� ) <br /> ` FOR DE TMENT USE ONLY 2 <br /> APPLICATION ACCEPTED BY: DATE:.SL � <br /> " 1t .%T.AR SUMP INSPECTED BY: DATE: <br /> - <br /> FINAL <br /> FINAL INSPECTION BY: <br /> COMMENTS: d 4eiC <br /> 'j ctl C C <br /> PECODE SC AMOUNT / RECEIVED BY DATE PERMIT/SERVICE REQUEST# SEPTIC IDN <br /> INFO RdMTTTED CASH <br /> o f d �a a o ZZS <br />