Laserfiche WebLink
LIQU"— WASTE PERMIT <br /> - SAN JOAQUIN COUNTY PUBL��JJLTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE.,3"' 'GWR,STOCKTON,CA 95202 (209)468-3620 ? H R ��r <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM <br /> nDATE ISSUtED <br /> NOB ADDRESS I 11�'�I`J ^'• jI�t r[JL.I TF G/!1 (l'�I fr /G(`I���i(lC P0. FLS •n•LL <br /> CITY/LIP� )101 1 PARCEL SIZE/APN /J •- fel C KC <br /> OWNER NAME PA(0 Db ADDRESS _[�N�1C Iar, - <br /> q <br /> � e, <br /> CRYrLIPuse1 In%� PHONE <br /> CONTRACTORN/CIL U. / 1M-'�-O) /4-,. ADDRESS 42/n- rI <br /> A.1 ✓TP�U� <br /> 2-AJ Z _ <br /> CITY?JP4,[)I�%1 �7 SZ" a P.... <br /> GEOGRAPHICAL INFORMATION:COORDIANTES: X Y TOWNSHIF_RANGE_---$ECTION <br /> PERC TEST(S)( )HOW MANY _ APPLICATION x: <br /> TYPE OF SEPTIC WORK: '� NEW INSTALLATION ❑ REPAIR/ADDMON ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ,'d OTHER I nY\L <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANKIGREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> _ C <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS f <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE LENT <br /> E2 FILTER BED WIDTH LENGTH DEPTH RECEIVED <br /> _ DISTANCE TO NEAREST.WELL FOUNDATION: PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH MAR 12 2001 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE—__aUOUNTM <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH - PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DISTANCE TO NEAREST: WELL FOUNDATION 1.PROPERTY LINE <br /> � <br /> ❑SUMPS WIDTH LENGTH DEPTH / i <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 COUNTY <br /> ORDIANCATE LAW'S,AND�U�1 ES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> _ SIGNED: Y:Z" ,f�/I� TITLE: DATE: / <br /> Ad 2L Z4 ,i/7L <br /> '7 7% L! I <br /> rfl- 71 1 1 ( it 1 <br /> _ I - <br /> I <br /> FOR DEPARTMENT USE ONLY ?� <br /> APPLICATION ACCEPTED BY: 1 /I I 11'1P( DATE:_� LL-1 <br /> 'TANK,PIT,OR SUMP INSPECTED BY: DATE. <br /> FINAL INSPECTION BY: <br /> COMMENTS: <br /> PECODE ScAMOUNT CHECKW RECEIVED BY DATE PERMIT/SERVICE REQUEST N SEPTIC ID# <br /> INFO REM CASH <br /> 4 - - <br />