Laserfiche WebLink
LIQUID WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br />3618 WEBER AVE.. 3ADFLOOR, STOCKTON. CA 93202 (209)468.3420 ' <br />NOON -REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED �"T . ' ' , J _ •� <br />JOB AODRESSS afG/ -S / /!� O ,J(- ' [:S : �'t. �Q- •/ij._■F- ..� <br />CITYlIJPLycl PARCELSIZF/APN --" �•''GJfY� alWw <br />OWNERNAME <<� / ISS ADDRESS C.YlM, <br />C[TY21P PHONE %27- SS V _ <br />CONTRACTOR lr. r�8_/z� .IZ%�� ��j� � ADDRESS GILD %4A, <br />CITYiL[P 11. Z/ PHONE3GS/ ;-d?7 <br />GEOGRAPHICAL INFORMA77ON: COORDIANTES: X Y TOWNSHIP_RANGE SECTION <br />PERC TEST(S) ( ) HOW MANY APPLICATION B: <br />TYPE OF SEPTIC WORK: ❑ NEW INSTALLATON dC REPAIR/ADDITION ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE tkCO-MMERICIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES: 12s' <br />CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH <br />❑ SEPTIC TANKIOREASE TRAP TYPEIMFO CAPACITY NUMBER OFCOMPARTMENTS <br />❑ PKG TREATMENT PLANT DISTANCE TO NEAREST. WELL FOUNDATION PROPERTY LINE _ <br />13 LIFT STATION SIZE TYPE OF PUMP SAND OD. SEPARATOR (ENCLOSED SYSTEM) <br />BLEACHINGLLVE NUMBER& LENGTH OFLINES___--3J� INFILTRATOR CHAMBERS <br />DISTANCE TO NEAREST: WELL .270 ' FOUNDATION lk _ PROPERTY L[NE a� r <br />❑ FILTER BED WIDTH LENGTH DEPTH <br />DISTANCETO NEAREST: WLI.L FOUNDATION: PROPERTY LINE <br />❑ MOUNDED WIDTH LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE _ <br />EEPAG PITS WIDTH _� LENGTH DEPTHS <br />DISTANCE TO NEAREST: WELL - FOUNDATION PROPERTY LINE <br />❑ SUMPS WIDTH LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />❑ DISPOSALPONDS WIDTH LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND TI IE WORK WILL BE DONE IN ACCORDANCE WITH SANJOAQUIN COUNTY <br />ORDIANCES, TE LAWS, AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED: - TTTLE:46-110� <br />DATE: 11 w <br />-10 <br />i 1 <br />Y [ 5 <br />1 <br />1 - 1 LL <br />1 1 II <br />urt- <br />Y G <br />D <br />I <br />FOR DFPARTM&tiT USE ONLY DEC 4 �[ �t <br />APPLICATION ACCEPI7:U BY: F/•Y-Vj DATE �C-Vq`� <br />TANK IT;?bR SUMP INSPECTED BY: T 1' C,ggl <br />tiTB:`c. L <br />FINAL INSPECTION BY: <br />COMMENTS � ( i SPIP <br />f- tM T I Wfll RID 1 <br />Pfi ODE SC AMOUNT RECEIVED BY DATE PERMMISERVXE REQUEST# SEPTIC ID# <br />cilo REM1OTTE0 CASH <br />250 15D Vaso i <br />-*qw lt�j .cmc/ <br />m <br />T <br />-01 <br />1m <br />