Laserfiche WebLink
LIQU- WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC SERVICES EM MOSMEN71,L HEALTH DIVISION <br /> 304 E.WEBER AVE..3"0F TOCKTON.CA Q= (209-468-3420 <br /> _ NON-REF INDA BLE PERMIT E\PIR S YEAR FROM D4TE IS<UFD Jrf 1q ,,y.���M�_ <br /> TT 2JE iC 5 5 <br /> JOB ADDRESS 7C �'`n ' �� � <br /> CITYMPi Gem _�f�r'� �(\\�� _ PARCEL SIMIPN S.��hG, �-L-.1'._-i •r-,1 1` - <br /> I <br /> C. Tc r_cCIL' BSc <br /> OWNER NAME; i;:•1n 1[r'vf IAP; 'S(-�I!'[.1(�i it vi ADDRFS]� C': r ll•(t�f= S �i{�� ti�- S���-/�"�"� <br /> CITYIZIP�!�}�I� i 'S. Mr,I:,t 14{ 4 IN Cttl,.S7,_PHONE ^� I <br /> CONTRACTOR�f1 t _ fT.[' T-�1 ( ADDAE55 �"T i��� Y���C 1"� f P4 - - <br /> CIT7121P�[''f i't ( � ��` i-L PHONE (,_,5� <br /> GEOGRAPHICAL INFORMATION:COORDIA`'TES: X Y TOWNSH:P_RANGE_SECTIOv <br /> PERCTFST(S)S�HOWMANY. APPLICATION-: <br /> TYPE OF SEPTIC WORK: [.7 NEW INSTALLATION ❑ REPAIR/ADD,—,,CN' CJ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMF.RICIAL ❑OTHER <br /> NUMBER CF LIVING UNITS: NUMBER OF BFDROOMS:_ SI_>IBER OF E\IPLCYELS:— <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER, WATER TABLE DEPTH <br /> (3 SEPTIC TA.NKr REASE TRAP TYPE)MFG CAPACITY NUMBER OFCOIIPARTpp"(�"_+n�n <br /> ❑PKG TREAT�MYNT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE _4�.IV' <br /> ❑LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR!ENCLOSED SYSTEM) AUGq �91 <br /> U LEACHING LINE NUMBER&LENGTH OF LINES INFILTR,A-OR CHAMBERS g <br /> DISTANCE To NEARFST: WELL FOUNDATION PROPERTY LINI5AN J040LJIII <br /> ❑FILTER BED WIDTH - LENGTH DEPTH ENNRONU.ENTAj.1,..+ <br /> DISTANCE TO NEAREST:WELL FOUNDATION; PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH - <br /> DISTANCETDNEAREST: WELL FOU'N'DATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTA.NCETONEAREST: WELL FOU'N'DATION PROPERTY LINE 1 <br /> I <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DfSTANCETONEAREST'- WELL FOUNDATION PROPERTY LI N'E <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION ANO THE WORKµ'ILL BE DONE IN ACCORDANCE WITH SAV JOAQUIN COUNTY <br /> ORDIAV ,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGN's��1 T11E:A7 /:I� 1 DATE: <br /> LJL <br /> i I I I i <br /> I I <br /> 1 <br /> i i I I ', i ,f I I I I � • <br /> II iir I <br /> I I 1 1 ' I' I <br /> I II I I i <br /> I E <br /> I I GCI I I <br /> ! III I <br /> i 1i I <br /> I <br /> - ' FOR DEPARTMENT USE OsLS' <br /> APPLICATION A:CFP"ED +�`-�= <br /> TA,YK.PTT.OR SV MP SFECTEDBY' / - DATE` <br /> FNALINSFECRON•B`.': <br /> COMMEMTS <br /> BATE <br /> PE CODE I W AMOUNT` RECE;vED BY I P[R�L„s:3t�'In i.��l'EST• SEPTIC WN <br /> ReMTRED` 'CXS <br /> d �^L� ���' r(t �- /'.j�- � •�� �.-AL1 i/ <br /> - I ' <br />