Laserfiche WebLink
LIQUID WASTE PERMITS �� N©Tt E i <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISIO �� E�TE <br /> 304 E.WEBER AVE.,3AD FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> ID <br /> li FOR ^L-1- <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED N S P E CT l O S <br /> JOB ADDRESS • ✓�"' �� � `' <br /> C1TYIZIP l PARCELSSIIZElAPN— <br /> OWNER NAME t I �• ADDRESS <br /> C[TYIZIP - PHONE A) <br /> �� zr <br /> CONTRACTOR J v`� " 'r ADDRESS ` <br /> CITYFLIP PHONE <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP_RANGE�SEC <br /> PERC TEST(S) ( ) HOW MANY APPLICATION#; <br /> i <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION D DESTRUCTION <br /> INSTALLATION WILL SERVE: ly L""SIDENCE ❑CQMML'RICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:42 / NUMBER OFBEDROOMS: `♦-f NUMBER OF E PLOYEES: <br /> 1 rG�"T�1l�hl WATER <br /> Vo <br /> RACIER OF SOIL TO A DEPTH OF 3 FEET: PITlSUMP SOIL CHARACTE ' <br /> EPTIC TANKIGREASE TRAP ii TYPEIMF CAPACITY 0 NUMBER OF COMPARTMENTS- _ <br /> KG TREATMENT PLANT DISTANCE TO NEAREST: WELL o4- FOUNDATION PROPERTY LINK <br /> I <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �Q EACHING LINE NUMBER&LENGTH OF LINES ! INFILTRATOR CHAMBERS , `` "N G S <br /> 'l DISTANCE TO NEAREST: WELIt.5,_.._FOUNDATION�� r PROPERTY LINE �d <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH i. LENGTH DEIlTH <br /> DISTANCE TO NEAREST: WELL r7� FOUNDATION PROPERTY LINE <br /> EEPAGE PITS WIDTH "[!/` LENGTH DEPTH CLI ) 41dp v f <br /> DISTANCE TO NEAREST: WELL _FOUNDATION Ad PROPERTY LINE <br /> i <br /> } ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH.DISTAN E T NE WELL FOUNDATION PROPERTY LINE <br /> I HEREBY C TIF THAT I HAVE REI ARE 'AP ICATION AND THE WORK WILT.BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES, 'TAT A W , ND LES REGULATI NS OF SAN JOAQUIN COUNTY. <br /> ' SIGNED: TITLE: ' DATE: <br /> i <br /> i <br /> r <br /> i <br /> �- <br /> '� G <br /> �S <br /> wA <br /> r- <br /> FOR DEPRTtt18NT US Y <br /> APPLICATION ACCEPTED BY: DATE: -✓ �� <br /> TANK,PIT,OR SUMP INSPECTED By A <br /> DATE: ' <br /> FINAL INSPECTION BY: <br /> COMMENTS: <br /> PE CODE SC AMOUNT RECEIVED BY DATE PERMITISERVICEREQUEST# SEPTIC Wit <br /> INFO R'F.MITT CASH <br /> Il a3 <br />