SU0001314 - Laserfiche WebLink

Home Browse Search

('i JOAQUIN COUNTY PUBLIC HEALTH $ERYICES ' u ENVIRONMENTAL HEALTH DIVISION RO. BOX 388, 904 EAST WEBER AVENUE:, STOCKfON, CA 9MI-m il, 1 ,, (202 468.3420 NON•11EFUNDABLE PERMIJ EXPIRES 1 YEAR FROM DATE ISSUED t {Complots in Triplieahl APPLICATION IS HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. T14I8 APPLICATION 18 MADE IN COMPLIANCE WITH BAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER f3-11 .3 AND THE DARDS pF SAN JOAOUIN COOU]�Y UC HEALTH S�IACES,E NMENTAL HEALTH DIVISION. JOB ADDRESBIOR APNS A(�`(// ,`/Y// Com, �p LOT SIZE A OWNER'S NAME o u I� ADDRESS PHONE 'CONTRACTOR ADDRESS ��y,�/J ADDRESS ' � �! BUB CONTRACTOR. LICO PHONE L /(// f/J// ADORER$ [„ i' Z'vr LIC, PHONY(Y�_] 4e ,TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIRIADDITION ❑ DESTRUCTION❑ f INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.( PERC TESTf+)I 1 HOW MANY I Apolosdo S ,INSTALLATION WILL SERVE; RESIDENCE❑ COMMERCIAL I.S - OTHER❑ //////777777 NUMBER OF LIVING UNITS; NUMBER OF BEDROOMS: NUMBER tlF EMPLOYEES:�� CHS A6J OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH 9�0_- SEPD ANKIOREASETRAP ❑TYPE)MFO CAPACITY f�(J(�Q-- NO•COMPARTMENTB_ � PKG TREATMENT PLANT 0 DISTANCE TO NEAREST: WELL �s� FOUNDATION___ PROPERTY UNE � UFTBTATION❑ SIZE TYPE OF PUMP - SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACHING LINE �10.!:LEN07H OF LINER f DISTANCE TO NEAREST:WELL «V FOUNDATION G O PROPERTY UNE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE♦017!1 11 DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE + SUMPS 1❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REOULATIO THE BAN JOA COUNTY.HOME OWNER OR LICENSED AOENT'SSIGNATURE CERUPIEBTHE FOLLOWING,'ICERTIFYTHATINTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 $SUE 1 SHALL NOTE PLOY AHY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR Suff—ONTRACTING BI TUBE CERTIFIKS THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 1S ISSUED,1 SHAM EMPLOY PERSONS SUBJECT TO RK 'e C PE LAWS O FORNIA.- THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FO EGURED INSPECTIONS. COMPLETE DRAWING BELOW, 8 NED X .�� TITLE . DATE: PLOT PLAN(DRAW TO SCALE)SCALE 'to 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE SOF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL BYBTEMS. 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 WALKS, THE PROPERTY OR ADJOINING PROPERTY. + .. .. ...,>. ...,. >.. - N Ff .......... a a a VG .. ..... ..,., .. - .. .. TfNGOUN TY Uv J NV:rAhr.rr RQNiyfN ...... . ....... ..,......, _ _ AF AL'HE,gf_TM UfV1Sfq(�. FOR EPARTMENT USE ONLY U APPLICATION ACCEPTED BY DATE: ••_— —. ... AREA: TANK,PIT OR SUMP INSPECTION SY DATE 1 ! FINAL INSPECTION BY DATE i 'ADDITIONAL COMMENTS: ( �' `� ter+ - P 6 -2- ACCO NTI 0 2-ACCOUNTING ONLY: AM# FACS PE CODE FEE INFO AMOUNT REMOITED CHEC ASH RECETVEO BY DATE SR 1 PERMIT NUMBER INVOICE S Pub,Health Serv.-Envlro.174(3/96)