Laserfiche WebLink
APPLICATION FOR U00-10 WAS ERMIT <br /> 111 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 384 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> t _ <br /> ,�a rfa ,NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM HATE13SUED <br /> - <br />' APPLICATION M NEREaY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CON67R7CT ANOfOR INSTALL THE WORK DESCRISEO THIS APPLICATION IS MADE M COMPLIANCE WftH SAN <br /> J4 ww COUNTY DEVELOPMENT TTRL CHAPTER 9.1.110,3 AND THE STANDARDS OF BAN JOAU M COUNTY PUSUC HEALTH SERVICES ENVIRONMENTAL HEALTH 0IVK6I0141. <br />+I SOB ADDRESSIDR ATNF_i.-1 I •.�•�• _- (/ 4 _ 1 i ',!,f !! 11 S 1 I_CR(Y I`I _l0T BRE <br /> ' .. OwIREA'S HlWIE �- ' 5 l I r�Y AOORESS 1 �' _.`` L/T f"Y l L i [71 J PHONE 4. <br /> 3 <br /> CONTRACTOR K'<.{1. -f:i i ; ADDRESS .1 3--1 i-�-.(." L.Vh ✓,f,;->( J LICE PHONE A2 <br /> +l: <br /> . 4 ADORLsB LIC! NRONF <br /> BU6 COMMCTOR <br /> _TYPE Of SEPTIC WORK: NEW INSTALLATION® REPA1PUADOIT1ON❑ DEITRUCTION E� <br />+i VNO SEPTIC SYSTEM PERMITTED 0 PUBLIC SEWER 10 AVAILABLE WITHIN 200 FEET OF BURDINOJ PERC TEATOF t i HOW MANY <br /> - <br /> INSTALLATION WILL SERVE: RESIDENCE AJ COI.KMmcmi.1•. OTHER 0 . <br /> NUNIBfiI OF LIVING UMTS: NUMBER OP IlmROOMt: NUMBER of EMPLOYETS: <br /> CKIAMCTER OF SOIL TO A DEPTH OF:$PUT- PrTfBUMP SOIL CHARACTER- WATERTABLE DEPTH <br /> aLT c tANKAM USE MAP <br /> t D tVPFJMFO CAPACITY' NO.COMPARTMENTS <br /> F� PKO TREATMIXT PLANT CI DIATANCE TO NEAREST: WELL FOUNDATION PROPERTY NNE <br />{ '1 LIFT STATION❑N�Al2E TYPE OF PUMP SAND OIL SEPARATOR!ENCLOSED SYBTEMI <br /> I LE1 wMG NNE L3 NO.SL.ENGTH OF ONES CISTANCE TO NEAREST:WELL FOUNDATION PROFERrY LME <br /> y PLT9L am 0 WIDTH LENGTH DEPTH DISTANCT TO N"M*T:YOM FOUNDATION - PROPERTY LME <br /> MCrUWM I❑WIrN <br /> �y DTH LENGDEPTH DrSTANCETO NEAREST!WELL FOUNDATION PRO PERTY.UNF <br /> I SL'[fAOE PIT6 -133 DEPTH �...WrE_ NUMBER DISTANCE TO NEAREST!WELL' FOUNDATION 1'MPPERTY LME <br /> ' -SUMPS DWIDTH LENGTH bEMN DISTANCE TO NEA/1EST:WELL.wuNDATwN PpapERTYUNE <br /> DISPOSAL PONDS ©WIDTH LENGTH DEERE DISTANCE To NEAREST:WELL FOUNDATION ' -PROPERTY UNE <br /> � <br /> L HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND T14AT.THE WDAL WILL-SE OONE W ACCORDANCE WTTN SAN JOAOLAN COUNTY ORDMANIC SU AND STATE.LAWs.AND RULES <br /> AN4 FIEGVLATIOIM OF THE BAN JOAWIN COUNTY:NOMEOWNE I OR SE <br /> UC AOEMr'a o(iNATURE CEFEME6 THE FOtLDYONO:'ICERTIFYTHAT INTHE FEIfG4WANCE OP THE WORK fOPIwkCH, <br /> I THIS PEMJIT a IariM(SHACL NOT VAKOV ANY.TrtRBON M SUCH A MANNER BLS TO BECOME SUBJECT TD WOIKMAN'S COMPENBATION LAWS OF CAUFDFIHIA-. C0klkACT0R'S MING OR <br /> LUS&CONTMCTLNG BMNATURE OERTIFKFB TTIE POiLOMIF16:_1 CERAFY:►NAT RI ITU,j4 FOMIAIICE DAACE WORK L RIbUlA IMIB'ViTtO.t,COMPLETE <br /> E E DRA WING BEL ERSDNE SVBUECT TD. , <br /> -- WowMAIYSTOMPBHSAt1O1!LAW*OF CAUFOIWIA. TN[AMEICAMT NOS7 CALL Z•HOURS IN ADVANCE TOR ALL IIEGUIRFa INSP[CTONS,'COFAPkTE b11A51V1F1G BELOW. _. <br /> F t / <br /> ' arGNEp X DATEt <br /> Ll <br /> r v �-t � I PLO7 fEJINFOR/Lw is BCALET aCALE <br /> ""' yr�MN■ r'HITTe,DiKi,�DiEt`yRAAE�rToa'iiBDOtrtGs�IEPrKOP�'+rrr' �H '` LnaATIDMocNDVAE�EvrinEa{aosl�L +'sTfEK� rnGPBaEb <br /> �4ar5� jF�'TH� B7P�6�flETlErS���IP'OD,eTPuGrINEB/ '� '4 r? -Tf€TVfY OH ! <br /> YY "'tt a sexy I'^a'4 <br /> II - <br /> kir <br /> E <br /> It I <br /> ,TEST AND SOIL BORING 1 <br /> I "I M I 8RAN6T ROAD 300 FEET WEST OF HYW 88 LOCKFORQ --..� Ai,'}i1:3'LTH <br /> .... . ..... <br /> f TOR OmART1AIXT Va[ONLY ] f <br /> AFLPUCATTON ACCEPTED BY- �l �l ''x ...r• �S 5 t. -i.t--.:�.P DATE:f�'../CJ AAEU,• <br /> r <br /> TANK,PIT OR SUMP INSPECTION BY OATF I I.. __FINAL INSPECTION BY DATE. <br /> ADDITIONAL COMMENTS ..5"� ..-. <br /> i AOOOL.TMo ONLY: ALDF FACE. <br /> 1 IPE CODE Fell AMOVNTHBAITED /C ASN mcav DiY DATE SR I POMT NUMBER R/VOICE <br /> F <br /> 'Pub.Health Serv. Envirc.174 01W <br /> S <br /> f <br /> I <br />