Laserfiche WebLink
LIQUID WASTE PERMITzo 2t' ..-1 -1 ° <br /> SAN JOAQUIN COUNTY PUIII.IC HEAUI'11 SFRVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WUBFR AVE.3p'FLOOR,STOCKTON•CA 9520? (2(Y))4(A-3420 <br /> NON RFFlINDABLE 1' RM IT FNPIRESti I YEAR FRAM DATE ISSUED <br /> 7_ 4 <br /> �Y `' <br /> JOB ADDRESS f± , f2, D r <br /> _/j" 7_ 1r PARCEL SI%Fl.al'N � ._LLu— ! J <br /> OWNER NAM F. ADDRESS 5 <br /> CITYIZIP_ <br /> CONTRA(--T-OR -��f:_L� �1_�' ADDRESS <br /> CITY/ZlP_S �JW ,, � �_ _ PHONE r r -5r! <br /> GFOGR.APHICALIN'F,O.RMATION: COORDLANTES: K_ — Y _TOWNSHIP_ RANGE— SECTION___- <br /> PERC TEST(S) (�Q HOW MANY -?I— APPLICATION u: -._ <br /> TYPE:OF SEPTIC WORK: �❑ NFW INSTALL ATION ❑ REPAIR/ADDITION Cl DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMN-IERICIAL ❑O'I'HFR <br /> NUMHFR CIF LIVING UNPIN: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES <br /> CHARACTFR OF SOIL TO A DEPTH OF 3 FEET:_ _ PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH _ <br /> ❑SEPTIC TANK/GREASE TRAP TYPETIFG—_ CAPACI"1'Y, NUMBER OF COMPARTMENTS <br /> ❑PKG'IREATMEN-I'PLAKI DISTANCE TO NEAREST-. WELL FOUNDATION PROPERTY LINI <br /> ❑LIFT STATION SI7E_ TYPE OF PUMP SAND OIL SEPARATOR(E.NCLOSF.D SYSTEM) <br /> ❑LEACHING LINE NUMBER&I.FNGT14OF LINES_- _—/ INFILH(ATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION — 4ROPERTYLINE <br /> ❑FILTER BED WIDTH LENGTII— -- DEP'IT I <br /> DISTANCE TO NEAREST: WELL FOLNDATION: - PROPERTY LINE. <br /> ❑MOUNDED WIDTH LENGTII - ._ DEPTH <br /> DISTANCE TO NEAREST: WELL F OI INDATTON PROPERTY LINE_. <br /> ❑SEEPAGE PITS WIDTH LENGTH __ DEPTH <br /> DISTANCE'IONEAREST: WELL. FOUNDATION PROPERTY LINE—__ <br /> ❑SUNIPS WIDTH LENGTH ._ DEPTH <br /> DISTANCETONEAREST: WEI.I. FOLINDA'TION 1'ROI'F.RTY'L1NE .. _ t <br /> O DISPOSAL.PONDS WIDTH _ LENGTII ._ DEP1 H C <br /> 'TANCE TO NF.ARF-ST: WELL _ FOUNDATION--- PROPERTY LINE <br /> I HEREBY CERTI ' I'IIAT 1 HAVE P RF.D'I' S APPLICATION AND T1IE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQGIN COUNT}' r l' <br /> ORUTANCF LA t• ,. AND 'C�A'I'IONS OF SAN JOAQI;IN COl'KT2'• <br /> SIGNED: I'ITLE: <br /> i <br /> �T I <br /> '• 7' Ij1 <br /> �,� <br /> I , <br /> s <br /> TIT <br /> FOR DEPAR'I'MFN I'I1SF.ONL.Y <br /> APPLICATION ACCEPTED By--./�( , r_ � ._ -. Dn'Ii.:��� <br /> TANF.PIT.OR Sl 1.10P INSP.0 <br /> I9NAL INSPECTION BY. _ <br /> L � <br /> COMMENTS__ <br /> 15 <br /> PF CoDF: Sr AMOUNT RECEI\'ED HY DATE• PER�•1YI , SL'1'[7C IDP <br /> [INFO RCMIITEO CASH - <br /> z1z Z -7 o 0 mod 73 t� <br />