Laserfiche WebLink
APPLICATION FOR LIOlIId WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> $04 EAST WEBER AVENUE,STOCKTON,CA 95202 0(3 - Q/yo-j' <br /> (209)468-3420 <br /> NOWItERINDARLE PERMq EXPIRES I MO FROM RATE 1$SIIFD <br /> Ic"NIpIILF in rTroRIFLFI <br /> APRJcATIDN M HERESY MADE TO THE SAM JOAOIAN COUNTY FON A PERMIT TO CCNSFRUCT ANEVOR NSTALLTHE WOIR DEFCRSED.THIS APPLECATNW M MADE IN COMPLIANCE wITN SAN <br /> JOAQUIN COUNTY DEVELOPJEHT TITLE.CHAPTER 8-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY MMIIO HEALTH OERYICES.ENVIRONMENTAL HEALTH DIVMION- <br /> JOS ADORSeIO%APH/ CITY <br /> 1 <br /> OWNDYS NAME is ADDRESS FMNE <br /> CONTRACTOR ADDPESS�fir9 1�.1t+_ A+e D.L...__-- lIC/ '/S"rJ�y F IONE,39� S�OZJ <br /> SUR CONTRACT00. ADDRESS UC/ PHONE <br /> TTYE OF SEFTIC WORK: NEW TNATAUAMON I& REPMN/ADDITIOR❑ DESTRUCTION❑ <br /> IND SEPTIC SYSTEM PERM WED IF RELIC SEWER IS AVAILABLE WITHIN 200 FEET OF SUIID#AEI.I 1+DIC TSSTiFI{T How MAZY <br /> E APPSeHfow F <br /> N"TALLARON WILL OERVE REtiTDERCE E9 COMMENCML❑ OTHER❑ <br /> MSAEEN OF LIVING UHITSi 1. NURSER OP"PAIIOOMS:- !d _MIMASHP OP BNR.OYEES; <br /> CHARACTER LTF SOILTO A DEPTH GIFT--- NJP <br /> ]1 FEET:�dd,//'1Z PITRAW SOIL CHARACTb5: WATER TABLE DEPT <br /> SEPTIO TAXIENIRFE TRAP 4J TYPEG / !� cAPACTTr -ka x> NO.COMPARTYNEN7'5�,�.:Z�. <br /> PEG TREATMENT PLANT[3 DISTANCE TO NEAREST: NIEII lJ Y FOUNDATION_ PMPERLY LINE <br /> UFT STATION t3YP <br /> SIZE TE OF PUMP .�/SAND OIL SEPARATOR#ENCLOSED SYSTEM y <br /> LEACHING UNE 16 NO,S V <br /> LENGTH Of IES �lG1J LHTTf/ mcz:TO NEAmwr,WELL f S�� FCIRmATN/N�PROPERTY UNE JD6} <br /> FILTERIEO CI WIDTH LFNOTN METH DISTANCE TO NEARESfY N'BL FOUNDATION PROPERTY LINE <br /> MOUNDED ©WIDTH uNOrN OFP H DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LNE <br /> SEEPAOE PITS ❑DWD SIZE HUMEER DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> SLIPS CI WIUTN LENOTN DIPTH DISTANCE TO NEAREST•.WELD FOUNOATTUN PROPERTY LINE <br /> DISPOSAL"NCS O VAMP LFNCTN DEFTN pUITAHCE TC NEAREST:WELL FOUNDATION PROPERTY LNE <br /> 1 HERESY C&M"THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WLl BE DONE M ACCORDANCE WREN FAN AOACUN COUNTY OMNANCES AND STATE LAW$.AND RULES <br /> AND ROULATIONF OFTIE SIU#JOAOUN COUNTY.NOME OMMEIORIICENSEO ACEMT'S OIONATUR CTRTIFES THE FOLLOWING:-1 CERTIFYTNAY NTHEPERFOPMAHCE OFTNE WORN PORWNIC#i <br /> THIS PERMIT M FOSUED.1 SHALL NOT EMPLOV ANY PERSON N SUCH A MANNER AS TO BECOME BUSJECTTO WORCMAS'S COW MSATION LAW"OF CAUTORCA'CONTRACTOR'O HIRM OR <br /> BUSCOTPAACTINO SIGNATURE CERFRTES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WMCN TWO PERMIT IS IBM",1 SHALL EMPLOY PEISUHS EULtWT TO <br /> WOIRMAN'S COMPENSATpM LAWS OF CyALIFA. <br /> ORM •TOE AFPIMANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED NEPECRONS.COMPLFMDNAHENG BELOW. <br /> GONEDR YES _ TiTLE:�f_—�d __DATE 9I Sk CJ__ <br /> TPLOT PLAN[DRAW TO ECALEI FC/LE <br /> 1.NAMES OP STREETS OR ROADS NEAREST TO OR ODVNDMLT THE PROPERTY. 4.LOCATION OF HOUK SEWAOE DISOSAL SYSTEM OR PROPOWD <br /> 2.DVR/NE OF THE PROPERTY.WITH DIMENOFIC <br /> lONS AND NORTH DIRECTION. EKPAHN OF SEWAOE DISPOSAL SYOTtMO. <br /> a.WMENMONED OVIUNES AND LOCAT WN OF ALL E IGTNO AND PROPOSED STRUCTURES. E.LOCATION OF WELLS WITILRN RADWS OF ONE HUNDRED FIFTY FT.ON <br /> IRCLUMNO COWED AREAS SUCH M PATIOS,DRIVEWAYS.AND WALKO. THE PROPFRTY OR ADAINNO PROPERTY. <br /> ... . <br /> .... <br /> id <br /> + � •r <br /> . <br /> ,........ C1 (�} <br /> . . ! _ 0! G( <br /> Q <br /> w <br /> 4 .. <br /> 0 <br /> r . .. .... <br /> I <br /> p/xYMENT <br /> ....... R. CIVED.. .. <br /> sE� s zaoa <br /> m� <br /> .. .. <br /> SAN JOAOUINCOUNTYe"—+"' ..,.�}� W © <br /> . ,.. . `..NSLIEHEAIIHSERVICES - �n <br /> HEALTy <br /> „<... VSROH}hEiuTw. .61N51�lL y <br /> r .. J <br /> EN �` f.. . .. . <br /> (/'�J �{/ FOR OFPAIIM UEE ONLY <br /> APPLICATIOPI ACCEPTED DY VT F ` aATE: �.��IO �O� AREA'" <br /> TANK,PT OR SUMP NSKCTIO14 BY DATE FINAL INSPECTION SY 2 T bATE� 1 l� <br /> ADORNONAL COMMEMS: WAZ <br /> 6-0 <br /> ACCOUXTIMO ONin MD/ FACT <br /> V�q <br /> FEE INFO AMOUNT MMITED CI#CIf/ ASH IacavEv Et DATE SR I FaI IT NRRR[R iNVO1C!■ <br /> f oo <br /> :5��ct,� <br /> Pub.HaalM 5erv.•EnArD.174(3188) <br />