SU0007296 - Laserfiche WebLink

Home Browse Search

30'01 JOAQUIN COUNTY PUBLIC HEALTH SERVICES # ENVIRONMENTAL HEALTH DIVISION' P.O. BOX 388, %A EAST WEBER AVENUE, STOCKTON, 6M—Al-M (2021469-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED IComplote In TTiplitAtul APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARD/SS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,EN AL HEALTH DIVISION. 'JOB ADDIIEB$/OR DPN# 2 - /'' {d / / �__CITY - 4"" LOT 61ZE 1 OWNER'S NAME _6e-, C,�-v - ADDRESS J �T/ PHONE CONTRACTOR-„�_I✓1 t l�N -. L. ADDRESS I !I th UCN W PHONF [�i, I& S 3.V-7 k SUB CONTRACTOR ADDRESS UC:T PHONE f TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIRIAODITION ❑ DESTRUCTION❑ VNO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTIS)I 1 NOW MANY Appllmdan 0 INSTALLATION WILL SERVE: RESIDENCE CtlMMERCIAL❑ 7HER 13'NUMBER OF LIVING UNITS: f NUMBER OF BED ODMS: NUMBER Of EMPLOYEES: ICH R OF SOIL TO A DEPTH OF 3 F PITISUMP SOIL CHARACTE c /K WATER TABLE DEPTH TAN EASE TRAP %TYPEIMFG �-Sc�+� CAPACITY_ /iZ� - NO.COMPARTMENTS E TREATMENT PLANT C3 INSTANCE TO NEAREST: WELL FOUNDATION �.S_ 1 PROPERTY LINE i LIFT STATION 11SEIZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEMI LEACHING LINE / NO.b LENGTH OF LINES Q t L r T- DISTANCE TO NEAREST:WELL I IL?_1'j' FOUNDATION '�" PROPERTY I LINE �V ' FILTER BED ❑oaWIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH.DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE y� r/ r SEEPAGE PITS P DEPTH �SIZE t!G NUMBER INSTANCE TO NEAREST:WELL to+"y FOUNDATION-&L'— SEEPAGE �IQ' .PROPERTY UNE GPC` _ SUMPS ❑WIbTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY,HOMEOWNERO CENSEDAGENT'sSIGNATURE CERTIFIESTHEFOLLOWINGI'ICEFRIFYTHATINTHEPEWORIMANCEOFTHEWORK FORWHICH /V THIS PERMIT IS $SUED,ISM Mp OY AHY PERSON IN SRC A NNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB-CONT TM GNA E NFI HE WING:'I CE I E-PERFORM E OF THE WOW FOR WHICH THIS PERMIT 19 ISSUED,k SHALL EMPLOY PERSONS SUBJECT TO A' WORK 'B COM 8 10 LA 0 A R A.' THE CALL 24 HOURS 1N ADVANCE FOR ALL REOUMED INSPECTIONS. COMPLETE DRAWING BELOW. IV BNGNE X TITLE; DATE: `�'� I Z PLOT PLAN(DRAW TO SCALE)SCALE 'to I. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. - EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON A INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. iLl .. .., ..: .., - 1 0 :. .. ... .. �, . ..... ' :. .. ... ...: ....... .. . . .. Y�✓ - _ _ - ...,..... (gyp. 9C0�:7 f IL s� . 7 .. ........ _ ...... .. .. .......... ... .... ... .. .. .. .... ... :. ..... .. . .... .. s..... ... :.. .. .....„. I :... .... ........ ....... . . ... '�� ,P' :... . ....:. ...RE lV ..... ..... �91N 1 :...1 7 S .FOR DEPARTMENT USE ONLY - __...... 7-, 7 _ APPLICATION ACCEPTED BY c - _ ___. _ DATE: AREA: //� �7 v TANK,PTT OR SUMP INSPECTIOII BY DATE ! 1 PENAL INSPECTION BY bATE,fp 1 ` t'417 ADDITIONAL COMMENTS: ( ACCOUNTING ONLY: AIDR FACO PE CODE FEE INFO AMOUNT,REMIITED HEC rCASH RECEIVED BY DATE OR I/PERMIT NUMBER INVOICE/ L?L 4LU / - ' �” V o2 -7 03g97� Pub.Heafih Serv.-EnvirG.174(3/96)