Laserfiche WebLink
06)1xof-' <br /> *"'APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 446 N. SAN JOAQUIN ST., STOCKTON, CA 962010388 <br /> (209) 468.340 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in TrpFwb) <br /> APPl1CATN)N IS HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A FEPMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED. THIS APPOCATION IS MADE IN COMPLIMCE WITH BAN <br /> JOAOUNI COUNTY DEVELOPSEFrt TITLE,CIIAPfEA 9-1110.3 RmO THE St NOAR'DIS OfSANJDAOUW COUNTY PUSOC HEALTH SERVICES.ENV�WDANMEHtAL HfMTH OMSN)N. <br /> JOB ADgE55OR APNS 4(3�y s L�ZT�YLQ_ ^C . CIf V /ILW, .{V- LOT S[Lpr J- <br /> OWNER'S NAME 12 u�.rxs AODIESS Tq'7+0� L6.'�� �r�.( ^�I�/O�tL/C/V! / EF«NIE 307- l,oi�' <br /> CONTRACTORS ��K ��•-[� ADOIESS/Z/C- tel."a// 11T a7•'�OIC. • • f RIONE 3�S3Y3 <br /> SUB CONTRACTOR ADDRESS LICS PHONE <br /> TYPEOF SEPNK WORK: NEW WSTAMATIONYJ <br /> REPAnvwmrmlE 13 nesTMOCTION❑ <br /> IND ME SYSTEM PERMITTED IF PUBLIC SEWER IS A WHNW 200 FEET OF <br /> S'UE�EDfD.11''1� Pe1C TESTI.)I I HOW MANY <br /> _ INBTIILLATN)N WILL i9NE IE6IDFNCE,16i, COEYEIICIAL❑ OTTER 0 <br /> Ea <br /> �1+a •I•IG�o lt, APOo0 <br /> Molle(OFM <br /> LNMINTS:-/— <br /> nNEMER OF SFOMOMS: 3 NWFR a BMROYEO: <br /> OF SOE TO A DEPTH OF J FEET: �f PffIBOMP 501E CHARMTFTCp�s � �G1bLfK/WATEA TABLE DEPTH <br /> IC TAU�FAiE TRAP ❑TwF/ESG le/nEi - e-' cAPAarY /Zd1J a.4/- No.coMPARTKEITrs oZ <br /> -� <br /> 11FATMB!!PIANT❑ vu rA To NEAREST: WELL f6C)` FOMO-TRR /�J` 111DPfRTY DALE 7c ' <br /> IFT STATION❑ SCE TYPE OF PUMP BAND OIL SEPAMTOR(ENCLOSED SYSTEM( <br /> LFACNNO DME NO.L LENGTH Of lBVEB - / ISTANCETO NEAREST:WELL /Od FOUNDATION <br /> LS ' PROPERTY UNE 7s <br /> FILTER nm ❑WIOTH LENGTH D PTN DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> MOUNDED � <br /> `❑WIOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> M65MOE FITS N OEPTN-9a_ NUMBER._OvTANCE TO NEAREST:WFll _FOUNDATION PNDPERTY UNE yS Y <br /> SUMPS ❑WIDTH LENGTH oEFIH DISTANCE TO NEATEST:WELLFOUNDATION RIOFERTY LINE <br /> _ DMPoSK PONDS ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROP (INE <br /> 9 <br /> 1 HERESY CERTIFY THAT 1 HAVE PIEPAREO THIS APRICATIDN AND TNT THE WOH[WLL BE WfE N ACCOIDANCE WITH SM JOAOI)W COUNTY 01DnIMIl8 AM SPATE UWB.AND RULLB <br /> ANPREGU <br /> NS OF TEBMJOAtlINCOUIRY.IDNEONFEBIORLICFNSm AOFIlT'YBN)IUTIRE CFRTWEBTHEFOLLOWRIG:'ICERIIFYTIUT NTIE PEI(OHEAMCEOFTIEW0IKFORWWCN <br /> c <br /> NtMCTjcSIGH FETHECFATIGS- EOftONV.M'6 CO 1 E CA1101MA.' TfE ANT UST CALL M IIMIIS M ADVANCE FOR(LLL 11E OUNIFOpUYR3:1NINn. COMRFTE 01111WMG BN11W.D% -TITLE, <br /> ROT RAN DRAW In 8CALEI SCALE 'm <br /> 1. NAMES OF STREETS OR MOORFNIPAREST TO OR BOIMONiG THE PROfEMY. Y. LOCATION OF HOUSE SEWAGE gSI'O6AL.SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISI SAL SYSTEMS. <br /> 3, DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED 6111UCTURE6, 6. LOCATION OF WELLS WITHIN MOIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED MFRS 6lMH AS PATIOS,OW VEWAYS,AND WMRS. THE PNDINR OR A0.01101I13 PROPERTY. <br /> ..: .. a. a ! - e.... .... <br /> _ :. - ._------ o ... �. <br /> 3/v'X2s �y . ...........ab1 <. ..... . <br /> �5 o <br /> rb®: <br /> .. ..> . . _._. <br /> r : ..._.. r <br /> ;. <br />