SU0004340 - Laserfiche WebLink

Home Browse Search

LIQUID WASTE PERMIT SAf>600QUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTALTH DIVISION )04 L.WEHER AVE 3N'FLOOR,STOCKTON,CA 95202(209)469 420 r `I ON-REFUNDA F,P'RMIT EXPIRES I YEAR FROM DATE ISSUED / Z'1 I � JOBADDRESS� � APN �1 �C (�� _ PARCEL SIZE.� O CITY/Z.IP"____. __ r-Le__ _P� BUILDING PERMIT#---) 2 ��/ OWNER NAME (, ) t E'� �JIr yL K ADDRESS--,a--�J_--2 9 47 TLd 11--d R CITY/ZIP __ PHONE NUMBER/__ QD(�`�Q // CONTRACTOR U,0\ � ADDRESS 6 / O / F� Z�Z � R el CI FV/Z.IP CJ i e iN !911;1111)111) PHONE NUMBER / _ 6 C�/ GEOGRAPHICAL INFORMATION: COORDINATES: X Y TOWNSHIP __RANGE SECTION TYPE OF SEPTIC WORK: .IINSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: tg NEW INSTALLATION 9 RESIDENCE NUMBER OF BEDROOMS: 3 _ ❑ REPAIR/ADDITION ❑ COMMERCIAL NUMBER OF EMPLOYEES: ❑ DESTRUCTION ❑ OTHER ❑ ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OI-3': PI.1'/SUMP SOIL CIIARA(]FIR: _ _ WATER TABLE DEPTIL_ ❑ PERC TEST(S) I IOW MANY_,,,, APPLICATI N# ` �f Ll SEPTIC TANK TYPE/MFG l o r�e PC- CAPACITY �l��C7 #OF COMPARTMENTS .G ❑ GREASE TRAP TYPE./MFG [[ CAPACITY #OF COMPARTMENTS ^ ❑ PKI:EX PLANT DISTANCE TO NEAREST: WELL ING FOUNDATION f PROPERLY LINK ❑ LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED rSYSTEM) \� ❑ LEACH LINE. #OF LINES: 3 LENGTH OF LINES: G DI,<?TANCF TONF.ARF.ST: WELI.-t!F?? FOUNDATION V PROPERTY I.INE INFLITRATOR CHAMBERS: '0 ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCF.TONF.ARF.ST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SEEPAGE PITS #A_ DIAMETERJ1 DEPTH�� DISTANCE TO NEAREST: WELL /{Jo FOUNDATION PROPERTY LINE )^� I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUIy 24 HMADVANytNOT E REQUIRED FOR INSPECTIONS-PLEASCALL(209)468-3423 SIGNED:_ P TITLE: C01 Y 0 ^ DA'Z'E: �' (u �' a-5 ^� I_._..ft........ff1_..............L�r......_..._........$;{_..... $i} I .... : . 1:: f :_ 44 ......_ ,: �: ; . . ; ..... ...�: .......a _- _ . ... ....j......... .... 1............ t.t....:...... ..........:... ..._..._....... -}- �. i...._- �..._.. 0 _.':... 1.... I .......i. ......... ...... . j--- - ' I _. ( i ; ; 70 ....... �t l.. ..._......t........... _ I � > ............._.........:..... - t-.i.... SAN JOAQUIN COUNTY _�� ,' EN IRONMENTAL HALTh1 C?EPARTMENT �$ S� �1- u� s ems ' r� I� �wsa4i . ................_............. .. PECIAL PERMIT -- 5� - (.. i....... 1EN�11R p t EtJTRI HE ALTN PIVl4iiiT. '_.. DEPARTMF,N'T l SE NI,V APPLICATION ACCEPTED BY:_ � t`-'� "C�- _DATE: Q�'AREA�i�_LEMPLOYEE ID# C) ` DISTRICT LOCATION l / INSPECTED BY: _ DATE: ` 00�r-0Z- PERMIT F ❑ YES DATE: INSPECTOR: CO -INSPECTOR. ENTs, _ /fin• / /�-O Z� � % OD� O.� A S do e1s11��c _ary / G 60 a /C e e1 PE CODE: SC INFO AMOUNT C11E1•K#i SII RECFIVFp I DAT[ PERM /SFRVIC:RFQUESTN IN\•OR F- SEPTIC ID# REMITTED BY RF.VISF.D P-IS-01 - _—_---"--