Laserfiche WebLink
LIQUID WASTE PERMIT�,� J <br /> SAN), N[N COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> (/] A� �yg� 304 E.WEBER AVE 3Y1 FLOOR,STOCKTON.CA 95202(209)469-3420 �/I�/1 <br /> JOB ADDRE5S 420 1 No" /M���REFU - B E PER TjXAIN' R FI OM DATE IS.SU� PARCEL SIZE:4 1 1 1 <br /> CITY/ZIP5TVG'P' pW /)...J5/w-`W� BUILDING PERMITp //r) COXJ, L/'J\ <br /> OWNERNAMMEE QI.(J�ll �1`\0 /A� S ,1f�O�\QI��`{A�A/6- �/-�/.��/��-/�//��ADDRESS 196'//4{/4� /��;AySI�TOi�I G� <br /> CIT'/ZIP IT'�-'w��))/� ///�)//�r� [[[������3��. IA/PHONE NUMBER / © ! /-1 I _ ( <br /> CONTRACTOR, ,A, P�o.0 5H' ' S7(//�C) ADDRESS 400L0�,--.�1N�82'�.-}7W�..-SOIV uv�y <br /> CITY/ZIP ST../+_Rt�oN 4 GA �y"�V PHONE NUMBER ' � 6 / <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP RANGE SECTION <br /> TYPEOFSEPTICWORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: <br /> x REPANUADDITION X COMMERCIAL <br /> ❑ DESTRUCTION L3 OTHER <br /> NUMBER OF EMPLOYEES: <br /> ❑ ENGINEERED/ALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: IIW 611W WATER TABLE DEPTH: 50 <br /> ❑ PERC TEST(S) HOW MANY APPLICATION# <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY #OFCOMPARTMENTS <br /> ❑ PKGTXPLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ,I <br /> LEACH LINE #OF LINES: I LENGTH OF LINES: I DIRFANCETONEARLST: WELL.O FOUNDATION 10 PROPERTY LINE S <br /> ` <br /> INFLITRATOR CHAMBERS: 5 aA- <br /> ❑ FILTER BED WIDTH LENGTH DEPTH_ DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED WHYTH LENGTH DEPTH DESTANCETONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH_ DISTANCETONF.ARENT: WELL FOUNDATION PROPERTYLINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL_ FOUNDATION PROPERTY LINE <br /> 9 t N <br /> SERFAGE PITS # L� DIAMETER DEPTH DMANCETONEAREST: WELowall-FOUNDATION�� PROPERTY LINE 1^ <br /> 1 HERESYCERTIFY THAT 1 HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS v <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. .- <br /> 1 �/� M NIMIje A A CE NOTICE REQUIRED FO�t INSPECTIONS L A5E C 309)46&3453 � OZ Z <br /> SIGNED:\ JIC,�T/I111X// .) � U4'/) TITL'• DATE: <br /> i <br /> I - <br /> _... �- --- -- -- --- <br /> tQ <br /> I <br /> I <br /> 1 y ..... <br /> I,J- - <br /> xxyrif <br /> I ---- - <br /> � i � L i <br /> it ILL <br /> P <br /> DEPARTM ENTU ,ONI - /�/ <br /> APPLICATION ACCEPTED BY: .�D`AI /iI 1 EMPLOYEE IDN STRICT ozOCATION�/ <br /> Tt <br />'INSPECTED BY 10 DATE�.+Wibi PERMIT FINA!-e YES 7D-ATP �C& <br /> COMMENTS: ✓ V/J <br /> PECOOE SC INFO AMOUNT CHECKM ASH RECEIVED DATE PERMITSERVICE REQUESTS I VOICER SEPTIC IM <br /> REMITTED BY <br /> 2 p S 31 1 <br /> lF.V1.SED FI W I <br />