Laserfiche WebLink
y, <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN <br /> ENVI <br /> ENVIRONMENTALCOUNTY <br /> HEALTH DIVISION <br /> SERVICES <br /> / 7� <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 Z� <br /> (209)468-3420 n f i <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete In TFipr"tol <br /> APIJCATION 19 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDOA INSTALL THE WOR(DESCRIBED. THIS APPLICATION IS MADE IN COMPIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOOPMEW TITLE. <br /> CHAPTER 9-1110.3 AND THE STANDARDS OF SAH JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENaVIR�ONMENTAAL HEALTH DIVISION. <br /> JOB ADDRESSM9 APN//-0"� F7� �/--���5 N1 LiT L' /CITY -JCI.T.)CJ'y.' / V LOT SIZE Z.Ar rt' <br /> OWNER'S NAME 1,rwNFF= �- F`/-/�/ ADDRESS /,��/.'�Y/� �� r �� f+7�� L� PHONE <br /> /// [�C�� r So "K c n N ,U/ 0 4--�Xn( �� <br /> CONTRACTOR�s� A ADDRESS A- <br /> SUB CONTRACTOR p / �'( - �`' ADDRESS LICE PHONE <br /> TYPE OF SEPTIC WORN: NEW INSTALLATION ❑ RE9ARADDITION DESTRUCTION ❑ <br /> IND SEPTIC SYSTEM PERMITTED IF WBUC SEWER IS AVAILABLE,WITHIN 200 FEET OF BUILDING.) PERC TFfTIF)1 1 HOW MANY <br /> SSSA Avon.".WILL SERVE: RESIDENCE ML OOMMERCIAL 13OTHER IJ <br /> NIMREI OF UNNG UMTS: III NUMBER OF BEDROOMS: -0V NLMSM OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> SEPTIC TANKAXIFAEE TRAP J� ❑TVPEIMM CAPACITY NO.COMPARTMENTS <br /> PPLO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY ONE <br /> UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEMI <br /> LEACHING ONE CK NO.A LENGTH OF ONEWf) r Y AYAznx DISTANCE TO NEAREST:WELLFOVNDATbN /e •+ PROPERTY ONE I`�"f- <br /> FILTER BED ❑WROTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY ONE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY ONE <br /> rt <br /> SEEPAGE NTS DEPTH 1-' SIZE -NUMBER_DISTANCE TO NEAREST:W111- � 'I FO <br /> " UNOATgH /On• PROPERTY ONE <br /> SUMPS ❑WIDTH�LENGTH <br /> Z / DEPTH �DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY ONE <br /> DHIPOSAL PONDS ❑WIDTH UENOTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOR(WILL BE DONE IN ACCOFDANC4 WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AID REGULATIONS OF THE SAN"AWN COUNTY.HOME OWNER ORUCENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT IN THE PERFORMANCE OF THE WOAIL FOR WHICH <br /> THIS PERMIT IB ISSUED.1 SHALL NOT EMPLOY ANY PERSON IN SACH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENBATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> 6VBLOMRARINO SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT 19 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION(AWS OF CAINIFS/OA. THE APPL/ICANT MUST CALL 24 HGOR$IN ADVANCE FOR ALL REQUIRED INSPECTIONS. E d COMPLETE WING)BELOW. <br /> SIGNED r f/ Y I!J ! 'I lM'�'t 1 /L. TITLE, `r7 f GATE: <br /> _- -33 <br /> ROT RAN(DRAW TO SCALE)SCALE_ •IP <br /> 1, NAMES Of STREETS OR ROADS NEAREST TO OR BOUNCING THE PROPERTY. 1. LOCATION OF HOUSE SEWAGE DISIMBAL SYSTEM OR P ROEOSEO <br /> 2. OUTUNE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISMSAL SYSTEMS. <br /> 3. DIMENSIONED OUTONES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUMORED FIFN FT.ON f <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY`OR ADJOINING PROPERTY. � <br /> IozsF rJWOQ1YJTbllnOli —I 4� <br /> b <br /> PQIxaalnMfol2w I�BksSF <br /> 9NI'SNOS4 HSNWdY <br /> 1 i <br /> A <br /> 1 I <br /> 1 PA <br /> • r w ww� K_ 'I �� � }� <br />