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SU0002671
EnvironmentalHealth
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ESCALON BELLOTA
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11655
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2600 - Land Use Program
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SA-99-42
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SU0002671
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Entry Properties
Last modified
11/27/2019 11:11:53 AM
Creation date
9/4/2019 6:07:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0002671
PE
2633
FACILITY_NAME
SA-99-42
STREET_NUMBER
11655
Direction
S
STREET_NAME
ESCALON BELLOTA
STREET_TYPE
RD
City
ESCALON
ENTERED_DATE
10/31/2001 12:00:00 AM
SITE_LOCATION
11655 S ESCALON BELLOTA RD
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\E\ESCALON BELLOTA\11655\SA-99-42\SU0002671\PUB REC REL APPL.PDF
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EHD - Public
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IFPLICATI0N FOR LIQUID WASTE PERMIT /,'ON �q9 <br /> SAI,,.�OAQUIN COUNTY PUBLIC HEALTH SE. ICES 1 <br /> ENVIRONMENTAL HEALTH DNISION 1 � ' <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 20 <br /> (209)AM-3420 m <br /> 3 NOM REF NDARLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (Complfts In Tripikatsl <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IB MADE IN COMPLIANCE WITH BAN <br /> JOAOUIN COUNTY DEVELOPMENT TT CH E' 9-1110.3 AND T STANbAR6 OF AN JOAQUIN COUNTY PUBLIC HEALTH SERVVICEB,ENVI NMENTAL HEALTH DIVISION. <br /> crrv_ �SCCJ !�I t LOT SIZE <br /> og JOB ADDRESS/OR API/ <br /> PHONE 7 <br /> OWNER'S NAME / I' ADDRESS rr fr <br /> �P/ •� ADORE88 or LK;# PHONE�,� <br /> CONTRACTOR - <br /> UCI PHONE <br /> SUBCONTRACTOR <br /> AbDIiE88 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION: REPAIR1A01'JITTON ❑ <br /> DESTRUCTION <br /> ❑ <br /> ,NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AV LABLE WITHIN 200 FEET OF BUILDING.) PER TEST(m)[ 1 HOW MANY <br /> APpYostlen/ <br /> INSTALLATION WILL SERVE-' RESIDENCE COMMERCIAL❑ OTHER❑ <br /> NUMBER OF LIVING UNITS: NUMBER OF f MS-- --- NUMBER OF EMPLOYEES: D <br /> CHARACTER OF SOIL TOA HOF a FEET: pTISUMP SOIL CHARACTER: WATER TAB PT <br /> SEPTIC TANIUa1EASE TMP ❑TYPElMFG <br /> L/r <br /> CAPACITY CO <br /> PKG TREATMENT PLANT❑ INSTANCE TO NEAREST: WELL <br /> FOUNDATION U' <br /> LIFT STATION❑ SIZE �.TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM) ' / <br /> LEACHING UNE A—HO.a LENGTH OF LINES <br /> �� f�/ _ :bISTANCE TO NEAREST:1MELL, - FOUNDATION PROPERTY UNEP — <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL <br /> FOUNDATgN PROPER'T'Y UNE <br /> MOUNDED (3 WIDTH_LENSTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> SEEPAGE PITS ID DEPTH SIZE NUMBER��INSTANCE TO NEAREST:WELL FOUNDATION��PROPERTY LINE <br /> SUMPa <br /> ©WB)T1i LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> INSPOSAL PONDS ❑WIDTH LENGTH DEPTH INSTANCE TO NEAREST:WELL <br /> FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WTH BAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS Of THE GAN JOAOUIN COUNTY-HOME OWNERORL)CENSEb AOENT'8 e1GNATURE CERTIFIES THE FOLLOWING:11 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FORWHICH <br /> TM9 PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO NroRCFOR W COMPENSATION 1918AW$OF CALIFORNIA.' CONTRACTOR'S PERSONS <br /> WRING OR <br /> a SU"ONTRACTENG BN3NA RE CEITTIFIE8 THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 SHALL EMPLOY pERBpNB SUBJECT 70 <br /> WORKMAN'S COMPENS N LAVYS OF CALI ' THE �Tmvs ALL 24 HOURS IN ADVANCE FOR ALL REOUIREO INSP'E/CTIONi. COMPLETE pMVINO BELOW- <br /> 816NE TITLE: DATE: <br /> PLOT PLAN IDMW TO SCALE)SCALE 'to <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOM SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. <br /> EXPANSIONION F SEWAGE THINDIGRADIUS <br /> SYSTEMS. <br /> 3. DIMENBroNEO OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. to <br /> OF WELLS WITHIN MpIUB OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY• <br /> ..... <br /> --.. 1. ...1. ........... .. - ...... .,......-.., ..., _ - .. ... ......... ---., . <br /> � . <br /> s'` SMS <br /> r� ... any <br /> : .. ` <br /> :.... . <br /> : <br /> �o <br /> ..... ..... . <br /> _ � <br /> .. <br /> . <br /> J <br /> C •� ! pp�� nn <br /> 1�©u..2.�1 .... . <br /> PUE3L+C}tF}1lTH 5ER111 ES <br /> ... .... <br /> �NyIR()NMENTAL H1=AL H Dl <br /> '.............. ..',..,-..-- .,....,....,.._., ...i......'....,....... <br /> FOR DEPARTMENT UBE'ONIY <br /> APPLICATION ACCEPTED BY Ar <br /> DATE: AREA: <br /> Af <br /> TANK,PTT OR SUMP INSPECTION <br /> DATEFINAL INSPECTION DATEI� l�S�3 <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING ONLY: AID) FAC# <br /> PE CODE FEE INFO AMOUNT REIMIITED CHECKNICASH RECEIVED BY DATE OR I PERIMT NUMBET INVOICE# <br /> I <br /> I Pub,Health Serv.-ERviro.174(,"1,) <br />
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