SU0002754 - Laserfiche WebLink

Home Browse Search

"AN JOAQUIN COUNTY PUBLIC HEALTH SERVICE'' .Y� ENVIRONMENTAL HEALTH DIVISION 1. ORII ��A '� P O. BOX 388, 304 EAST WEBER-AVENUE, STOCKTON, CA 9520 a K Lv ��P Y (IT E )RES I20 I G! NA L NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Comp1BR In Triplicate) A ATON 18 HEREBY MADE TO THE BAN"AMIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOR(DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH BAN .JOAGUIN COUNTY DEVELOPMENT TITLE.CHAPTER Ill 1110.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH OPASION. JOB ADDREGSIOR APNF /f1 i✓ 4 1? 9 1 CITY ZA-N d Po LOT SIZE J_I OWNER'9AME /?,4lls-,6'ISJ,— 1 ADDRESS ^��(/�Cyy/1 ' P10NE /\ t' 7 CONTRACTOd ZA W G 4 1/�e" n ADDRESS 5�fo(w TO FU LIC) PHONE BUB CONTRA.CTOP ADDRESS LIC/ PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPA1NADDITION ❑ DUTRUCTIo NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IB AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TEBTHI I I)IOW MANY I JNSTALLATION WILL•EINE: RESIDENCE❑ COMMERCIAL❑ OTHER❑ NUMBER OF WINO UNITS: NUMBER OF SMROOMS: NUMBER OF EMPLOYEES: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANKIGREABE TRAP ❑TYPE/LLFO CAPACITY NO.COMPAATMENTS RIM TREATMENT PLANT❑ DISTANCE TO NEAREST: WELLFOUNDATION PROPERTY LINE LIFT STATION❑ SIZE TYPE OF PIMP SAND OIL SEPARATOR(ENCLOSED SYSTEMS LEACHING LINE ❑ NO.6 LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE FILTER BEG ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE PTB ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATMN PROPERTY UNE SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE DISPOSAL"NOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOR(WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE BAN JOAGUIN COUNTY.HOME OWNER OR LICENSED AOENT'B SIGNATURE CERTIFIER THE FOLLOWINO:'1 CERTIFYTHAT M INE PERFORMANCE OF THE WOR(FORYMICH THIB PERMIT 18 ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR-8 HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOO WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA: THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOP ALL REQUIRED INSPECTIONS. COMPETE DRAWING BELOW. SIGNED K ///L"T7 � i/fk' TITLE:(JEM-T_] F'�-r DATE: �!•� —/S r'� PLOT RUIN;DRAW TO SCALE)SCALE -Ro 1. 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. EKPANBON OF SEWAGE DISPOSAL BYSTEMB. 3. DIMENSIONED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. JCIS(A /) �CI'4 I) _ x ' . .. PAYMENT _.__..��------- FEB' 31999 JOACITJIN PUBLIC HEALTH SERVICES.. ENVIRONMENTAL HEALTH DIVI910 �((�//�) ♦ }/�I �� FOR ARTMENT USE ONLY �� APPLICATION ACCEPTED BY(MA/AT f .?k DATE: �' 1 1 AREA: Z( TANK,PIT OR BUMP INSKCTIO14 BY V DATE I / FINA4INSPECTRON BY DATE Z I �S ADDITIONAL COMMENTS: T' ACCOUNT...ONLY: AD/ FACS PE LODE FEE INFO AMOUNT RFMIITED CIIECK/ ABN RECEIVED BY GATE BIR I PE INT NUMBER INVOICE B s131-I cy OI osUsa Pub.Health Sam-Enviro.174(3/96) /O-2G-9Q oR/G/oNHIC L'/FN No7' 3,� �p(LND T-///S 15 ra tiE 4SCZ 6S 4 R6PA'W'SfMelt-7- ` ��J.,-