Laserfiche WebLink
LIQUID WASTE PERMIT <br />SAN JOAQUIN COUVTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br />304 E. WEBER AVE)" FLOOR, STOCKTON. CA 95 202 (209146X -34M <br />JOB ADDRESS-.�--� <br />_ NON-RF:FUNDARI.E PERMIT EXPIRES 14E.A�Rj FROM D T IS.SL, ED <br />S �'L-i7i I�[%.+a C. C' �l APN_y-I OOI D PARCELSIZF:_ <br />C. <br />DEPTH__ <br />U NEW INSTALLATION <br />U RESIDENCE <br />NUMBER OF BEDROOMS: <br />CITY/ZIP 1�,�GL c� <br />h G- L: <br />BUILDING PERMIT 0 <br />DF.P'FH <br />OWNER NAML mac) -" $( �-- <br />/ I �,/'--r lj L <br />ADDRESS��J <br />NUMBER OF EMPLOYEES: <br />�— <br />//��J'i` <br />CITvfZIP F- f 7L�./ 4 4 <br />PHONE NUMBER <br />Ll OTHER <br />olAiancE n: N[ARIAT: <br />WELL <br />Ll ENGINEERED/ALTERNATIVE <br />❑ DISPOSAL PONDS <br />CONTRACTOR_— +� /Jf <br />� � C CJ JCv y <br />PITISUMP SOIL CHARACTER: <br />Ui-valp �J • � <br />J .� �"/ J J <br />PHONE NUMBER <br />APPLICATIONn__._,__ <br />DIAMETE0. <br />GEOS.iRAPH1CAL INFORMATION: COORDINATES: X <br />Y "TOWNSHIP RANGF. SECTION <br />TYPE OF SEPTIC WORK: <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: _ <br />DEPTH__ <br />U NEW INSTALLATION <br />U RESIDENCE <br />NUMBER OF BEDROOMS: <br />❑ MOIL\DBD <br />Jd REPAIR/ADDITION <br />❑ COMMERCIAL <br />DF.P'FH <br />DIWANCETOKEARLAT: <br />WELL <br />FOUNDATION <br />NUMBER OF EMPLOYEES: <br />WIDTH_ <br />❑ DESTRUCTION <br />Ll OTHER <br />olAiancE n: N[ARIAT: <br />WELL <br />Ll ENGINEERED/ALTERNATIVE <br />❑ DISPOSAL PONDS <br />WIDTH_ <br />LENGTH _, <br />CHARACTER OF SOIL TO DEPTHOF3';_— <br />PITISUMP SOIL CHARACTER: <br />WATER TABLE DEPTH: <br />FOUNDATION <br />❑ PERCT£ST(S) IIOW MANY _ _ .. <br />APPLICATIONn__._,__ <br />DIAMETE0. <br />DEPTH <br />❑ SEPTIC TANK TYPE. MFG <br />CAPACITY <br />OF COMPARTMENTS <br />❑ GREASETRAP TYPEIMFG <br />CAPACITY <br />4 OF COMPARTMENTS <br />L�}� <br />❑ PKC'1-IC PLANT DISTANCE TO NEAREST: <br />WELL__ FOUNDATION <br />PROPERTY LINE <br />A ' <br />❑ LIFT STATION SIZE <br />TYPE OF PLMP SAND OIL <br />SEPARATOR (ENCLOSED SYSTEM) <br />tl OF LINFS: ! LENGTH OF IANF.S: LI[) <br />O LEACH LINE DKTANC.[TONG[GST: <br />WELL C `_1/ FOUNDATION PROPERTY LINE <br />rU , <br />INFLITRA"I"OR CHAMBERS: <br />❑ FILTERBED <br />WIDTH <br />LENGTH <br />DEPTH__ <br />D1.4TANCETONEARLST: <br />WELL <br />FOUNDATIUN <br />❑ MOIL\DBD <br />WIDTH <br />IENOTH <br />DF.P'FH <br />DIWANCETOKEARLAT: <br />WELL <br />FOUNDATION <br />® SUMPS <br />WIDTH_ <br />LENOTII,_LZ- <br />DEPTH __/O <br />olAiancE n: N[ARIAT: <br />WELL <br />FOUNDATION <br />❑ DISPOSAL PONDS <br />WIDTH_ <br />LENGTH _, <br />DEPTII <br />on.-rwncxTO N[AR[AT: <br />WELL <br />FOUNDATION <br />❑ SEEPAGE PITS <br /># <br />DIAMETE0. <br />DEPTH <br />D.TyNCETO-AD 1M <br />WELL <br />FOUNDATION <br />PROPERTY LINE <br />PROPERTY LINE <br />PROPERTY LINE <br />PROPERTY LINE <br />PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE. IN ACCORDANCE WITH SAN JOAQUIN COLNTY ORDINANCES. STATE LAWS <br />AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. (� <br />�JINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 461.3423 <br />SIGNED: � 4, `^ti� _TITLE: %--c.J �� DATE: ,/ <br />DFPART lF.NT USE ONLY 't}�S7 y/ <br />APPLICATION ACCEPT" BY: _ DATE/ { -C�•AIIF.A EMPLOYEE IDM ` ! ` DI RICT LOCATION99 <br />INSPECBY �D/ATE:_1���/f1.2 PERMIT FINALYFJ DATE INSPF'CTO - <br />COMMENTS:. <br />�f2)rb I /tS I ISD <br />