SU0002754 - Laserfiche WebLink

Home Browse Search

'ENVIRONMENTAL HEALTH DIVISION P.O. BOX 386 "14 EAST WEBER AVENUE, STOCHTON. C' )S201-W �4w (209( 4883420 -� NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Cempl$b In Trlplic$b1 AFPUCATION 18 HEREBY MADE TO THE SIU!JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH SAN JOAWRl COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THHE�n".ANDARDS(O�F BAN JOAGUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION, /� JOB ADDIIEBBIOfl APNI 1117M 5 60a.1 Vh, Y\T> 6( CITY 4 07471('L.> (; //.,-[I I, (� -.r /� 1 'r /- LOT BIZ �7 ]( OWNER'S NAME 4-�1�T F. /: ✓!L�i )-V) ADDRESS rad lyy�H. r /�,/)J CJs 11 E &7 ..E 3']C- a�b CONTRACTOR �V/G-1�1�5 9'L)M 1 I�ADDRESS IO o(OF 1 Ca /Af:4 UC/ (3 PHONE J 1-i ' 4 M CONTRACTOR ADDRESS I� =a ATONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPANVAOOITION y DFATIILOTION ❑ (NO SEPPM SYSTEM PERMMED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PEHC TEATIE)1 I HOW MANY -��LM Apptloetlon S INSTALLATION WILL SERVE RESIDENCMA) COMMERCIAL ❑ OTHER ❑ NUMBOR OF WNG UNITS:_ NUMBER OFFBQJ h BE OT�MS,: _ NUMBER OF EMPLOYEES: ✓j 1 CHARACTER OF SOIL TO A DEPTH OF 3 FEET: . & V PITISUMP SOIL CHARACTER: WATER TABLE DEPTH LAE o SEPTIC TANKIOREASE TRAP ❑TYPEJLIFG CAPACITY NO.COMPARTMENTS MG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE Ol �A LEACHING LINETON lk SIZE NO.6 UNOI,H OF UNEBOF PUMP� —111 ��r�DISTAN111- TCE TO NLOSED EAREST:YWELL T PROPERTY LINE's)o / OI FILTER RED m ma LENGTH DEPTH DISTANCE TO NEAREST:WELLS ' FOUNDATION AbPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE RTS 11DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE BUMPS ❑WIDTH LENGTH DEPTHDISTANCE TO NEAREST:WELL FOUNDATION GL6J PROPERTY LINE 22y DISPOSAL FONDS ❑WIDTH IENO rOTH U DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNF IN +X O 1 HEREBY CERTIFY THAT 1HAVE PREP T A C DONE IN ACCORDANCE HATH BAN JOAOUIN COUNTY ORDINANCE$AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOMEOWNEROR ENBEOAOE .NATURE CERTIFIES THE FOLLOWING:'I CERTHYTHAT IN THE PERFORMANCE OF THE WOW FOAWHICH tti THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION"We OF CAUMANIA.- CONTRACTOR'S HIRING OR BUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWI%-1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALM IA.' APRT ANT MUST CALL 24 HOURS IN ADVANCE FOR AM REQUIRED INSPECTION$. COMPLETE DRAWING BELOW. 61GNED X '_I - - / TITLE: ( .E n O DATE: C:l;Ir OT IDRAW TO SCALL)SCALE 'to 1. NAMES OF STREETS OR ROADS NEAREST TO OR TNF PROPERTY. 4. LOCATION OF HOUSE$FWAOE 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 INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALXS. THE PROPERTY OR ADJOINING PROPERTY. O \� 1 �V t FC) �F ti ti w N� as.b ,9f d � F $ r % �P`YT� HAi~ik 'IAN JfjFULAN COUror -: PL801C HEALTH SMIICEE FOR DEPARTMENT USE ONLY APPUCA1 ION ACCEPTED BY DATE: 2 AREA: TANK,PIOR BUMP INSKCTIO14 By DATE I / FINAL INSPECTION BY DATE !:R-1 // 197 ADDITIOP AL COMMENTS: �OVC•YDv 68�hW F'} �raM.uJLLuIW / ACCO NITRO ONLY: AIDS FACS PE DE FEE INFO AMOUNT SEMI I TED CREC,.l ABH I RECEIVED BY DATE SII/PERMIT NUMBER INVOICE! 015 I47-1 L4 ski O//S3(�:7 Pub.Health Sew.-Enviro. 174(3/96)