Laserfiche WebLink
LIQUID WASTE RMIT <br /> SAN)OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER.AVE_J°i FLOOR,STOCKTON.CA 95202 (209)-168-3420 <br /> N'ON WFUNDA1t I.P.PERMIT EXPIRES I VE'AR FROM DATE ISSUED /t G <br /> 4 ADDRESS �U�7-� /' '•NV <br /> CITYfL1P / /,•A � PARR7CE�L�SIZ�FJAPN <br /> OWNER NAME/ll/SIJ SCS/� //A/:_ADDRFLS__<1 NG_ <br /> CITY/"LIP ,Q PHONE <br /> CONTRACTOR ��� ///i( //1 L��f- /� ADDRESS e��,-J� <br /> CITY/ZIP��� G_� PHONE 93/—Z,6 r-{ <br /> CEOGIi.APHICALINI'OI2MATTON:COORDIAN"I'I:S: X Y TOK'NStlIP_RANGE SI:CIION__ <br /> FERC TIST(S)( I HOW MANY APPLICATION#. <br /> TYPE OF SEPTIC WORK: ❑ NEWINSTALI.ATION X REPAIR/ADDITION ❑ DES"i'RIICIION <br /> INSTALLATION WILL SERVE: `,x(t FSIDENCE ❑tOMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNI"1'S: NUMBER OF BEDROOMS' NUMBER OF EMPLOYEES <br /> CIIARACPCR OFSOIL"FO A DPITII OP 3 ��//1z PIl7SlIMP3UIL CIIAItACI'ERWnl'FR"i"Altl.li Dlil'I-I v_ <br /> ❑SEPTICTANKIGREASEIRAP TYPFJMFO CAPACITY NUMBER OFCOMPARTMENTS_ <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNUAITON PROPERTY LINE <br /> lir ' <br /> ❑LIFT STATION SIZE__ TYPEOFI'UMP SAND OIL SEPARATOR(ENCLOSED SYSIIM) <br /> ,.LEACHING LINE NUMBERS LENGTH OF LINES / /_:� INFILTRATOR CHAMBERS / <br /> DISTANCETO NFAREST: WELL FOUNDATION PROPERTY LINE S6 <br /> -� ❑FILTER BED WIDTH LENG"fH DEPTH <br /> DISTANCE TO NEAREST:WELL FOUNDATION. PROPERTYLINE <br /> ❑MOUNDED NVIDT14 LENGTH DEPTH <br /> yy DISTANCETONEAREti I': WELL FOUNDATION PROPERTY LINE__ <br /> -� 1CTSEEPAGE 1'il'S WIDTH LENGTH DEPTH 25_J <br /> DISTANCE TO NEAREST: WELL( '�FOUNDAI"ION PROPERTY LINE__ _ <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE I"O NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 1 HEREBY C' tIF THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,S ELAVvs,ANU F.S A.' REGULATIONS OF SAN JOAQUIN COUNTY. r// <br /> i SIGNEI��� �� TITLE�J V �� <br /> DATt: <br /> I <br /> i11 _ C <br /> JI , . <br /> IENVR' NPit T rI 1 <br /> 3. Rr 1IT SF C <br /> U � <br /> I <br /> i <br /> � OIt BELABTAIEN'L SE ONLY I I ) <br /> APPLICATION ACCEPTED BY <br /> -fit- AI'E <br /> TANK, fTOR SUMPINSPECTED BY _ i1r <br /> low COMMENTS: <br /> INSPECTION BY�__j/ /{'/ U <br /> COMMENTS: <br /> PE CODE SC AMOUNT 'Hf.Cli./ RECEIVED BY DATE PERMITISCRVICE RE(;l♦EYfIM:�' SL:PI'IC'ID, <br /> INFO R,.111TEI) I�. <br /> L4 L-T- rills K <br />