Laserfiche WebLink
�. .4./ Itrj? <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAOUIN INTY PUBLIC HEALTH SERVICES <br /> f✓! ENVIRG._,TiENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 AFM <br /> � i7�,�1'U7riAl�1�Tt�i T`c,F,l� <br /> NDN'REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED .. ' <br /> ►CempMtB M TrWitat#1 <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNrY FOR A PERMIT TO CONSTRUCT ANDMFI INSTALL THE WONT DESCRIBED.THIB APPLICATION IB MADE IN COMPIJANCE Y2H NON <br /> LE, <br /> JOAGURN COUNTY DEVELOPMENT TITCHAFFER 8.1 110,3 AND THE STANDAIIOS of BAN JoAOUN COUNTY PUBLIC HEALTH IOUPACES,ENVIRONMENTAL HEALTH DIVISION. 'f` 4� <br /> w s- - 812 . <br /> JOB AODREBB10A APNP Lr ..]` r� 17G>r" L�IJ I �. CITY �F. J <br /> L �� f, „�=�Fi`'l' <br /> OWNER'S NAME ,, L-LY[± AppREsa 1Cr�11 �"" At AYTE PF,�L +C.A�7557 PRONE'v 4^ ��!} <br /> r CONTRACTOR ADDRESS LIC• PHONE <br /> SUBCONTRACTOR —Mo— PHONE <br /> 1 TYPE OF SEPTIC WORK: NEW INSTALLATION Q WPAIHIADDITION❑ DESTRUCTION❑ Ir <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IB AVAILABLE WITHIN 200 FEET OF BUILDING.) PERO TEDT'1 tl1 HOMY MANY <br /> 3 INPTA[LATISN WILL BONE: RESIDENCE❑ COMMERCIAL Q OTHER Q 1 GJ I <br /> F'�KcoL.r1TL�I'+ R� I�jC7-4,.LX�{-fi'1 <br /> NUMBER OF LVANO UMTS: NME66t OF BEDROOMS: NUMBER OF BMPLEEA <br /> OY : <br /> CLAY/R"I' 'T <br /> CHARACTER OF BOIL TO A DEPTH OF 3 FEET: S i L.* C_I_Ai_ PITISUMp SOI.CHAfUCTEA: WATER TABLE DEPTH Id 'VAL""Lti&t:+L)IS1 A <br /> at"C TANKJOPMASE TRAP T ❑repE/MFO CAPACITY NO.COMPAHtMENT6 <br /> PKB TREATMENT PLANT L.J OISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> UFT STATION❑ SITE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM( <br /> ""M"a LINE Q NO.•LENGTH OF LINES "STANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> FILTER#ED ❑WIDTH LLNatI DEPTH DISTANCE TO HEAVIEST:WELL FOUNDATION PROPERTY UNE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> SEEPAGE PITS ❑OEM SIZE NUMBER DISTANCE TO NEAFIEST:WELL FOUNDATION PROPERTY LINE <br /> "Mm <br /> (3WIDTHiiii_LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUfGAT1ON PROPERTY UNE <br /> 11 DISPOSAL PONDS 13 WIDTH LENoTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> i <br /> I HEREBY CERTIFYTHAT I HAVE PREPARED THIS APPUCATION AND THAT THE WONL 1MLL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE TAWS.AND RULES <br /> AND REGULATIONS OF THE SAN JOAOUIN COUNTY.HOMEOWNER ORLIGENSED AOENT'S SIGNATURE CEITUREB THE FOLLOWING:'I CERRFYTHAT INTHE PERFORMANCE OF THE WORK FORWHICH <br /> THIS PER Mrr NB ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WOIKMAN'B COMPENSATION LAWS OF CAUTOWSA.' COMRACTOR'e HIRING OR <br /> BUB.CONTRACTINO SIGNATURE CERTIFIES THE FOLLOMND:11 CERTIFY THAT IN THE PERFORMANCE OF THE WORK rOR WHICH THIS PERMIT fS ISSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REBUKED W SPECTIONS, COMPLETE DRAWING BELOW. <br /> BIONEOK �'� TITLE: DATE: n`- <br /> Vv'/LL4£iti' Tc G.3F'Tl5 <br /> PLOT PLAN(DRAW TO 6CALE1 SCALE—'t <br /> I.NAMES OF STREETS OR RDADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2.OUTLINE OF THF PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> G G.DIMENSfONED OVTUNES AND LOCATON OF ALL EXISTING.AND PROPOSED STRUCTURES, 6.LOCATION OF WELLS WITHIN RA"US OF ONE HONORED FIFTY Fr.ON <br /> MCLUDRIG COVERED AREAS SUCH AS PATIOS.DRIVEWAYS,AND WALKS. THE PROPERTY OJAN p <br /> R ADJOINING PROPERTY. <br /> ....: <br /> LQ <br /> .. <br /> .. .. ....... <br /> ..., -.. — <br /> ... .. N <br /> . .� ..... � Pll911C NEt1LTtISEHVIGE <br /> FNARONMENTIU flF.Al rh M;l' <br /> s ....,. ....: .. <br /> SO> <br /> ...... .. ..... b.... <br /> K <br /> .... ' . ... <br /> .. <br /> . 1 <br /> A I � <br /> a ...�sPH <br /> .. ..... .. cyDLD ..I .. oF�GFILtA0 <br /> TC <br /> .. --,. Q LRTLot•a <br /> 1� 4 pIPRa4 <br /> t <br /> 9r�2 LCI= s <br /> ... .. ... <br /> I - p,E,c�ct $ 'WAI{l��tsAl:. slt. <br /> ZN <br /> ....... <br /> ... b. . <br /> FOR DEPARTMENT USS ONLY 7%-6 <br /> ��V <br /> A ] <br /> APPLICATION ACCEPTED BY DATE: Z [7 Z I AREA: J <br /> TAM[,PH OR SUMP INSPECTION BY DATES_FINAL INSPECTION BY <br /> ADDITIONAL COMMENTS: <br /> =P7— <br /> FAC# <br /> CHECK# ABH REGOVED BY DATE SR!POWAT NUMBER INVOICE# <br /> '�lo 22. 0�-- <br /> Pub.Keafth Sem.•ERairo.174(3/96) <br />