Laserfiche WebLink
LIQUID WASTE PERMIT <br /> SAN JOAOUIN COLN'1 Y PUBLIC IILiAL'1'll SERVIC ES FNVIRONMENTAL HEALTH DIVISION <br /> 301 E.WEBER AVE..P'FLOOR.STOCKTON.CA 95202 '209)468 1420 <br /> � p NI)N.REFUNDABI F PERMIT EXPIR"I YEAR FROM DATE ISSI'ED <br /> I /] <br /> JOB ADDRESS_ a 7 A I , <br /> CITYt,� _..._ 7iyl <br /> 2IP �iC� - 3. �, '._. ... . IS <br /> __._PARCEL SIZE/APN /y �� <br /> OWNER NAME _ ADDRESS b / O __ <br /> / r _ <br /> CITY/ZIP_ PHONE ' "6.,.so or��t'i_. <br /> CONTRACTOR ADORE"_SSp���JJ <br /> CITY2IP <br /> GEOGRAPHIC:ALIKFORMATION:COORDIANTES: X... - -Y-__TOW'.VSHIP_RANGE_SECnON__ <br /> PERC TEST(S)( )I IOW?ZANY / APPLICATION r: <br /> TYPE OF SEPTIC WORK: ❑ INSTALLATION REPAIRIADDITION 13DESTRUCTION <br /> INSTALLATION WILL SERV,',: RFS IDENCE ❑COMMERICIAI_ ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OE BEDROOMS:_ NUMBER OF EMPLOYEES:_ <br /> CH.ARACII:TC OFSOIL T•O ADEPT H OF)FEET: -_ I'I P7SIIM1'Sp1I.CHARACTER:_ WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPE/MP(; CAPACITY NWU)HR()PCOMPARTMENTS__. <br /> ❑PKGTREATMENTPLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYUNE <br /> ❑`IJFI'STATION SIZE TYPEOFPIIMP�y G-S?I)01).SFPARA'I OR I FNCI.O.SFD SYSTEM)_,-•,^ <br /> .Q LEACHINGLLVE NUMBER&I.ENGCII OF LINES/ <br /> '! �' INFILTRATOR CHAMBERS �y <br /> DI.STANCETONI:ARL'ST: WEJ_L V NDA7ION ! D ?ROPER /` <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEARF_SI: WFJ.I. H',H:NDA'1'ION:- PROPERTY LINE <br /> ❑MOUNDED WIDTH LF.NG'I'll_ DEPTH <br /> / DISTANCE TO NEAREST. WELL _ FOCNUATION PROPERTY LINE <br /> ❑SEEPAGE PIIS WIDTH '�d LENOTN _DEPTH <br /> DISTANCE TO NFARF.TM WHI.IPMOC—FOUNDATION OPERTY LINE-__S_j� <br /> ❑SUMPS WIDTH__. LF.NGOI DEPTH <br /> DISTANCE TO NFARESM WHI.1. FOLINOA'IION_ PROPERTYUNE <br /> ❑DISPOSAL PONDS WIDTH _ LFNGTH DEPTH _ <br /> DISTANCE TO NFARFST, WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WU.L BE DONE IN ACCORDANCE WITH SAN JUAQUIN COUNT <br /> ORDIANCE�S.STATE LA WS,AND RU AND REC.UL TIO:S OF SAN JOAQUIN COUNTY_ <br /> SIGNED: TITLE:6F+ DATE. <br /> I <br /> _.. I r) <br /> APPLICATION ACCEPTED BY: 1�, �,�RA�YTGiRNT USE ONLY ?Oki <br /> f j BA'IIi•_. t. <br /> TANK.614 SI'MPINSPECIEDBY: <br /> FINAL I'SPECTION BY: <br /> COMMEN)S_`~ �✓�.f/J i� �./ �rr�� �u c� �t��, _ _ <br /> W.amw SC AMOUNT KM RECEIVED ON DATE PFAMIT:SCRV:CC REQUEST R SEPTIC 100 <br /> INFO R_MITE) <br />