SU0012397 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIOUIO WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WESER AVENUE,STOCKTON,CA 95202 (209)466-3420 NON-REFUNDABLE PERMIT"PINES f YEAR FROM OATS ISSUED (CGNPISIN In Tri'Ibal APRICA l—11 HEREBY MADE TO THE GAN JOAOUN COUNTY FOR Pff"m TO CDNS7R/CT ANMVP NNTAIA THE WOM DESCRIBED. THIS APPLICATION IS MADE N C—PL-1 VITAL MN JOAOUN COUNTY DEV4LOPIA TIRE.1NAPEER`5'A 110/.j1/7M/IRO:THE GIT OP GAN COUNTY PUBLIC HEALT^NJ�GE/�1ROC/E/G.ENVGV)M��tNTTALL�HEALTH dNGGN, JOG ADDRESSOR AT'J/I � W. 1.�• '/"' � /'/��J,,, �H C' /!"^1 /`�J�� p{�IDT GQrg?L— `J oIYNER'B NAME�A JNUlI6 Af� �>(� �/� MIONF I+�O 097 CONTRACTOROR ADDRESS LRCS /NONE SUBCONTRACTOR ADCPIEGS LCP '/IIORE TYPE OF SEPTIC WORK. MEW m/TALLETRON❑ REPAMADSIr"N❑ PUTS—no" PAD SEPTIC SYSTEM PERMITTED IF F'JBLIC NEW"IG AVAILABLE WITHIN 200 FEET OF NALOSN0.1 / PEFIG TIOTNI I 1 HlIN GIANT B,// A..B...r I INSTALLATION Wu N BOE: IWWMNCV❑ COMMERCIAL$( OTHER❑ ��✓` '��P� M114q OF LIMNS LNITI: NUN10,91 OF IEDROOMI: MUMSII OF IEAPLOYMS CHARACTER OF SON.TO A DEPTH OF]FTE7:_ PITMUMP WB CHARACTER: WATER TABLE UEPT1L_ SEPTIC TANKARI AGB MAP ❑TYPEJMFO CAPACTTV NO.COMPARTMENTS_ PRO TREATMENT PLANT PANT U DISTANCE 10 MEAGNdT: WELL FOUNDATION PHOPUTTIRLNE LIFT STATION 11 SIZE TYPE of PUMP OAHU OI.SEPARATOR MUCLOSEO 9MFMI LFACNNO LINE ❑ ND.S LENGTH OF UK@_ DISTANCE TO NEATEST:WELLFOUNDATION PROPERTY UNE MTWI mm ❑YAM LEWM DEPTH DISTANCE To NEAREST:WELL FOUNDATION PROPER"UNE MOUNDm ❑VmTN LOMTH�__DEPTH DISTANCE TO NFAII[BT:WF1.L FOUNDATION P/IDPER YLINE SUPAOE PUB ❑OVTN an__MUMEER OISTANCE TO NEARER:WELLMUNDATdf PPMpM Y UNE SLEEPS QNB WIDTH IErII _OEIFTN DISTANCE TO NEARER:AELL FOIMDATION PIRO ERTY LINE DISPOSAL Q PONDS WIDTH LTN ITN DEPTH OICTANCE TO NEAREST:WELL—_FOUNDATION PROPERTY URE 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE N ACCORDANCE WITH VAN JOAQUIN COUNTY OPI NANCEB AND STATE LAWS,AND RIAEI AFDPIRK"TKM9 OF THIO BAN MAOLM COUNTY.HOME OWEER OR LCOHIM AGENTYSIGNATURSIGNATURECEIRIFIES THE fOLL&ABIO:'I CURTIPY TINT NIE TMV400WAAHCE OF THS—PLL POR V&WH THIS PERMITTT IG ISSUED,I MAIL HOT EMPLOY ANY PERSON N SUCH A MAANER AS TO BECOME SUIL ECT TO WORGLMAPfS COMPERNATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR IUS-CONTRACTE4O SONAN CEWIFES THE POLLOW NO:'1 CERTIFY THAIN THE PERFORMANCE OF THE V40M IDA WHICH THIS PIPWTT II NNEO.1 SHALL DRROY PERSONS SUBJECT TO WORKMAN'S COUPENSAT WS OF C Ii RMA.'TAPPNGANT MUST CALL JH MUM N ADVANCE FOR ALL RWLE INSPECTIONS.MMIR TE DRAWING BELOW. ' 3 GOREDX TITLE:_ DATE: PLOT PLN ORAW TO SCALER SCALE_'ro 1.NAMES OP STREETS OR ROADS NEAREST TO OR BOUND"THE PROPERTY. 4.LOCATION OF HOUSE SFWAOE OWQGAL EYNTEM OR PROPOSED 2.OUTUNE OF TIE PW OPERTY.WITH OSAENSIONG AND NORTH DNECMN. EXPANSION OF WWAOS DI IPOSAL SYSTEMS. a. DIMENSION10 OUTLMS AND LOCATION OF ALL EO frRUCTUEG, S. EXISTING AND PROPOSLOCATION Of WELLS WITHIN RADIUS OF ONE HUNDRED FKrr FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS.DAVFWAYIL AND WALKS. THE PROPERTY OR ADMNINB PFOPIREY. ` .... ... �.E. . . .... .. .. . .. . i r ........ ....... • i:rT,n�3N nFPri it FOR—ARTMINT—ONLY A/RICATION ACCEPTED BY DATE: / MEA: TAMC,PIT OR SUMP NM4R N BY ' -,DATE124& 1—.N I.T—SY ADDITIONAL COMMENTS: ACC*MW-ONLY: ADI LACI PE CODE FEE INFO AMOUNT KING$TIED ASN RfrNvw By DATE "I mwnwm INVOICE F .7- 7 c�I Pub,HSSIEI Serv,•Enwo,174(3196)