Laserfiche WebLink
APPLICATION FOR LIOUIO WASTE PERMIT <br /> �q SASTT JOAQUIN COUNTY PUBLIC HEALTH Stw,110ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 488-3420 <br /> NON NEF NDADLE PENMtT EXPINE! 1 TEAR 1110111 DATE IIIUED <br /> fe"k f In Tr4Nattll <br /> AP"ATION M IMI//'/MAN TD TM SAN JOAOUNL COUNTY ROA A RR.OT TO CONSIRUCT MIDMIT MSTALL THE WOR(benMBED. VMS APTLICATIUN R MADE IN COMPLIANCE"IN SAN <br /> AAOUO f`OINrTT OfVILOPSMMT mW CHAPTER/-1110.1 ANO STAIIOAM11 Of nouNl COUNTY PUBM NEALTN SFRVOa.EIMIONME ITAL HEALTH DIVISION. <br /> t�f� �n S r��� ErtY J DI SRF_ <br /> Joe AoorcewR ATNF t/0. �/ /� � 7,0 <br /> OW1011'S NAMf < ADODEe ) `IL' fq(Q"C1' <br /> toMRACtoR C f'i1�•Y C , r4"S AOOREee'g�� T`I�- La ��(t 4 uc/ l��AIONEJ 11L(U�-� 1 <br /> C/ MIONF <br /> 9"CONTRACTOR ADDRESS <br /> TYPE OF eEPTC WORK: NEW INSTALLATION MWAIRIFADDITION ❑ DESTRUCTION❑ <br /> IMO SEITIC SYETEM PERMITTED IF RIBLIC SEWER IB AVAILABLE WITHIN 200 FEET OF BUILDINO.I PERC iaThl l I HOW MANY <br /> MFBn.tlnn/ <br /> INSTALLATION WILL$E f-. MSIDFNCE❑ COMMERCIAL ❑ OTHER ❑ <br /> NUMBER OF"NO UMTS:_ NUMRM of of1M00 Sr "mmm OF Sh"MoYEEA: / <br /> CHARACTER OF SOR TO A DEPT"Or G FEET: PRT/SUMP$OIL CHARACTER: WATER TABLE OEPTN�� <br /> SEPTIC TANK "Of TNM RTYPE/MFo CMACITY NO,COMPMMEMB <br /> PRO TRFATMEMT PLANT 11 DISTANCE TO NFMEIT: WELL FOUNDATION Pf OrEPTY LINE <br /> UFT STATION❑ MILE TYPE OF NMP SAND OR SEPARATOR NNCLOSM SYSTEM) <br /> LFACNMG UNf ❑ NO.•IENOTII OF LINES DISTANCE TO MAPSWELL FOUNDATIONM <br /> �T- OMPTY UNE <br /> FILTER BED 2 X ❑WIDTH7IFNOTH �OEPTII dETANCE TO NEAREST:WELL FOUNDATION��/ PROPERTY UNE -� <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEARESTI WELL FOUNDATION PROMRTYLINE <br /> $MADE RTS ❑DEPTH SIZE NUMBER Dlfll` CE TO NEAREST:WEII FOUNDATION PROMRFY UNE <br /> BLMM ❑MOTH UMTII DEPTH DRTANCE TO NEAREST:WEII FOUNDATION MOMRTY LINE <br /> PNPOSAL PONOS wal" LENOTN DEPTH DISTANCE TO NEAREST,WELL FOUNDATION MIOPERTY LINE <br /> 1 HEREBY CHITIFY THAT I NAVE PREPARED VMS AIMICATON AND THAT THE WORK WILL BE DONE IN ACCORDANCE MRH SAN JOAQUIN COUNTY OMRNA M AND STATE LAWS,AND RULER <br /> AND REGULATIONS OF THE SAN"ROUST COUNTY.HOME OWNER ORILCENSEO AGENT'S KONATURF CERTIFIES TIM FOLLOWING:-I cerMYTNAT INTHE PERORIAANCE of THE WORK MAWHICH <br /> TMS PEWIT IS toBVED, ALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO W ADMAN'S COMMNBATION LAWS OF CAUFORMA.' COMRACTOR•S MRENo OR <br /> BUB-CONTRA:T. NA URE CERTIFMTV THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WOR(POR WHICH THIS PERMR IS ISSUED,104ALL EMPLOY PERSONS SUBJECT TO <br /> WOPKMAN'S CO NBAT N LAWS OF-CAALIMPHIA.•ZYMANT MUST CALL 2t LOURS IN ADVANCE FOR ALL REOM M INSPECTIONS. COMPLETE DRAWING BELOW//I�. /ynMONEO• w TRLE: DATE: <br /> ROT MAN MRAW TO ECALID SCALE 'lE <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR ROUNDING THE FROMNfY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROMSED <br /> 2 OUTLINE OF THE PROMRFY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAOE ORPOSAL SYSTEMS. <br /> J. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND FEIOMSM BTRUCTUMe, S. LOCATMIN OF WELLS WITHIN MOLLIS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVOEO AREAO SUCH AS PATIOS,DREVEWAYe,AND WALKS. THEPROPERTYOR ADJOaNO PrOMRTY. <br /> 5... C Lam..�PgRUIT <br /> cif 1IT <br /> It <br /> 'A Iry <br /> n I i <br /> s h I. <br /> C <br /> I J <br /> - R 2`'8 1999 <br /> 5/b c T <br /> }, �E9 <br /> f� :.. 1 F.. iH DM9ON <br /> .S,F l 4 <br /> : <br /> a IM ld NWAY 6 <br /> 1 YAt <br /> _... ......L. ......L,. <br /> 1JX//,J/I11//��[`J1�AI (//� �_ __. on.D TILT BE or{Lr ✓ n�'vq <br /> AM IC AT 1011 AC Ct rt to nY (\, • -V +• --DATE <br /> TANK.RT OR RUMr NIBPEC'mu R�Yp / DATE I / pFINAL INSPECTIONBY DATE r , <br /> ADDITIONAL COMMENTS:q-I X 11 1 � /1/ 1 /- R' �0 yp(( /.. <br /> Rf OVC H. jAVm um s lPO.H — y - r <br /> ACCOUNTING ONLY: AIDr FACE <br /> Of FEE IMO AMOVNT IIFMIREO CIIFCK/ AS11 RECDVEDBY DATE MlPDRfT NLtlNSM1 INVOOf/ <br /> 2 t 9y L$ 3a4 9 73 <br /> Pub,Heetlh Serv.-Enwro. 174(3/89) <br /> Y�/d <br />