Laserfiche WebLink
LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> ` SM E.WEBER AVE JN:FLOOR,STOCKTON,CA 95203(M)yµ.3.$1 <br /> ��� �� S �O L4 NODN/R�EFVNDABLE PERMIT EKPI RES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 APNZI�[ �� 1 /�� 0 <br /> L y../. _, r A- PARCeL81ZC 9k 30 <br /> Cm/ZIP 1 1 !✓ICJ.I (' fJ trx <br /> Lock <br /> aml.olNc eeRMlrF__( <br /> OWNERNAME_ GVN Loc cf.R J <br /> F( [� �` ADDRESS <br /> L CITY/LP Y�yn 1fN 1 .An' <br /> R PHONE NUMBER <br /> CONTRACTOR <br /> _�__�1/� <br /> �A w ADDRESS <br /> CITVMP YY 1 rAA (r} A^y <br /> —�� � PRONE NUMBER <br /> GEOGRAPHICAL INFORMATION:COORMEATM x <br /> L Y TOWNSHIP_RANpE�3fCTgN <br /> 7TYPEOFSEPTIC WORK: INSTALLATION WILL SERVE: <br /> �Y,'/NEW INSTALLATION —/ NUMBER OF LIVING UNITS: <br /> P4RESIDENCE <br /> ❑ DESTRUCTION <br /> ❑ COMMERCIAL NUMBER OF BEDROOMS: 3 <br /> V ❑ ENGNE RED/ ❑ OTHER NUMBER OF EMPLOYEES: E <br /> ❑ ENCMEEREDIALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF2': S-o.IPI. f _ <br /> PIT/SUMPSOIL CHARACTER: JCA WATER TABLE DEPTH:_ <br /> �[ ❑❑ PERCTESTISI HOW MANY u APPLICATION# <br /> UY�SErt¢TANK TYPvMFO P' ` CAPACITY [h 66 <br /> pOFCOMPARTMENTS. IFL <br /> ❑ CREASE TRAP TYPE/MFG(3R <br /> SIRR <br /> 1 #OFCOMPARTMENTS PNGI'x PLANT DISTANCE TO NEARESE: WELL G CAPACITY 1 + <br /> FOVxpwryON PROPERTY LINE/mo 1\ <br /> 13 LIFTSTATION SIZE yypEOp PIMP <br /> SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0,-`LEACH LINE #OF LINES: -� LENGTH OF LINES:SQ WELL'U6! 'j <br /> ouTArvK mx[AR[[T: FOUNDATION&6 PROPERTY DNE_yO <br /> � INFLITRATOR CHAMBERS: <br /> ❑ FILTERBED WIDTH— LENGTH DEPTry •� <br /> __ oaMNCEiox[ARui: WELLFOUNDATION_ <br /> PR OPERTT LINE�� <br /> �NDEO WIDTH LENGTH <br /> — DEPTH__ OYiuK[ioxu[[m WELL — <br /> / FWNOATNRI PROPERTY LINE <br /> ` SUMPS WIDTXLEN4TH 1 01 Rat <br /> 1L DEPIHyV AYC[TDN[ARUT: WELL_, FOUNDATION�I PROPERTY LINE 3OI <br /> 13 DISPOSAL PONOS WIDTX_ LENGTH DEPTH_ Raie:K[ipn[M[m WELL <br /> FOUNDATION_ PROPERTY IJ HE <br /> 13SEEPAGL PITB # pLW¢}FA� DEPTN� pIR[Ay[[TON4RYi; WELL <br /> FOUNDATION— ppppE0.TY ONE_ <br /> JOB, 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINJn]UIMF5__UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE,CALL 1309)IW-212] <br /> SIGNED: [ .M�.'j_> TITLE: A�T]TL�CLfiBJ <br /> ` DATE: �_ R Q� <br /> L <br /> L <br /> I <br /> L <br /> i <br /> 1 <br /> L <br /> s� <br /> la N <br /> �. <br /> B EAL <br /> DEPARTMENTU E LY N <br /> APPLICATION ACC PTEOB DATE REA [ E <br /> � MPLOYEEiD# D _LOCATION//yy�� <br /> INSPE BY.. l <br /> DATE: PERMII'FINkLtl yFS DAT♦: <br /> NS �— <br /> COMMENTS <br /> ` PE CODE SC INFO AMOUNT F ASH RECEIVE. DATE PERMITRERVICE 0.EOUF3T[ <br /> REMITTED RT INVOX'E[ SE TICIM <br /> r. <br /> REva[o[.IFRI <br />