Laserfiche WebLink
LIQUID WASTE PERMIT .,. <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ` �) <br /> 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 (2(9)-I68-3420 <br /> NON-REFUNDABLF.PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ff I <br /> ,/ C�i( <br /> JOB ADDRESS- L b rl-(SLI <br /> CITYIZIP �� l n PARCEL SIZE/APN <br /> OWNER NAME. °J i( ; ADDRESS - Q <br /> CITYlZIP PHONE <br /> r <br /> CONTRACTOR jo.jl/e pt ft,,/- <br /> _^ r y� <br /> ADDRESS �n 60Y tet- <br /> CITY/ZIP !V• c,j4,4GL..j �1 g� 3� PHONE p�3S'=77 li <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSHIP RANGE SECTION <br /> PERCTEST(S) ( )SHOW MANY APPLICATION M: <br /> TYPE OF SEPTIC WORK: {� NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: + ESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: ` NUMBER OF BEDROOMS NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: J c�hQ PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MFG 104 � CAPACITY-i 4(g 6 0 NUMBER OF COMPARTMENTS <br /> ❑PKGTREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION �QJ PROPERTY LINE •S t <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> tdLEAIFCHING LINE NUMBER&LENGTH OF LINES / &0, INFILTRATOR CHAMBERS <br /> 1 <br /> DISTANCE TO NEAREST: WELL�I OnJ FOUNDATION 16 PROPERTY LINE -3'Q) r <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION: PROPERTY LINE <br /> ❑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 /> ❑SUNIPS 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 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN�TAI <br /> ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> a SIGNED: �JVv /F�L�Ce TITLE: `�L' �<<.15 f DATE: l) <br /> I% <br /> i <br /> ITI I <br /> 'lull <br /> 1 <br />