Laserfiche WebLink
i <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> RDIUREFUNOAREE PERMIT EXPIRES!YEAR FROM OATS 15SVED <br /> W,-*6t.IB TEip6R1u) <br /> APPLICATION 14 HEREBY MADE TO THE BAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AN'DIOR MBTALL THE WORK DESCRIBED. THI$APRJCATION b MADE IN COMMIIANC!WITH SAN <br /> JOAOUN COUNTY bEVflOP,/ENT TRILL,CHAPTER 8-1110.3 AND THE STANDAFOS OF GANrJOAQUN COUNTY PUBLIC HEALTH fERVTCES,EwmFo MEENTAL HEALTH DIVISION <br /> JOB ADM8MR Al.. .2 212- Ste: ,f���C.n�-7 ] / CITY w LOT <br /> OWNER'S MIVAE //U JZJ p ADORE- p[/�)�� / .9ry/f .'ip- LJ PHONE__ <br /> CONTRACTOR <br /> SUB CONTAACTOR ADM 86 LIC! F1 E <br /> TYPE OF SEPTIC WORK'. NEW INSTALLATION REPARIADDITON❑ D"TM1CT IN❑ <br /> IND BEMC SYSTEM FSRMfTTEV IF PPISHC SEWER IS AVAILABLE WITHIN 200 FEET OF BUMMING.) --Ti...I—MANY <br /> WSTALLAtON WILL BENE: MUOENCES( COMMERCIAL Cl OTHER❑ <br /> MIIMSUI OF LTING IIMTS:�_NUM\91 OF fmROOW: � NlMS81 OF 13APOYKS: <br /> CHAAACTEA OF SOILTO A OEPTH OF J FFET:_ TIMP SOIL CHARACTER: / WATER TABLE DEPTH <br /> SVIIC TAMRIGREARE TRAF ❑TYPUMU; J /PSU_CAPACITY �//TSP_ _ NO.GOMPMTMENrB_S <br /> MG TREATMO/T PLANT 11 EXATANCE TO NFAIIFDT: WYEIl /db>L`Y FOUNDATOH POPERTYLNE�27D <br /> UFT STATION❑ WE TYPE OE PMP�SAND OK SEPARATOR IENCLOMD BYBTEMI _ <br /> LEACHING UN <br /> NE NO.\LENGTH OF LE$ T <br /> 70^ F T NSTANCEO NEAIIEBT:MrELL�FOUFMATON�PRDFERTYUNE/fC"'� <br /> FLTSP SM ❑WIDTH LDQTI{_ DEPTH DISTANCE TO NEAREST:WELL FOUIpAT10N PROPERTY LINE <br /> MOUNDED ❑WIOTII LENGTH DEPTH DStANCE TO NEAIIEST:WELLFOWOATIDN PROPERTY LIFE <br /> SU FAG1 RTS ❑d DEPTH SIZE IAAAWR O—ANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> sLIMPS OI WNTN�_tENOTN � D[PTFI/D/- gSTANCE TO REAM gT:WEll,,�FOUNDATRINT Pf10PFATY lNE'G>T/ <br /> DISPOSAL FONDS ❑WIDTH LENGTH_,DEPTH DISTANCE TO NEAREST:WELL_FOUNDATION POPERrYUNE <br /> 1 K1ESY CEITIFY THAT 1 HAVE PLPAIED TMS APPLICATION AND THAT 711E NIDFSK WILL BE DONE W ACCORDANCE WITH BAH JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND IRRFB <br /> AND FW(RI AT10NS OF THE SAN JOAOUM COUNTY.HOME OWNER oR LICENSED AOENT'S SIGNATURE CERTIFIES THE FOLLDAMNO:'1 COMFYTHAt LATHE PEIYOIMANCE OF THE WOPK FOR WIKH <br /> THIS PIRMFT HI MPLIM,I MULL NOT EMROY ANY PERSON N SUCN A MINER AS TO BECOME SUBJECT TO WOWMAHV COMPENSATION LAWN OF CALIFORNIA.- CONTIIACTOR'B FUSHG OR <br /> PIBCONTRACTTNO SONAtURE CERTIFIES THE FOLLOWINO:'I CERTIFY THAI'IN THE PERFONAANCE OF THE WORK FDA WHICH TM PE R,1R IS ISSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MWT tALL 24/OURS IN ADVANCE FOR ILLL NOLINED DUPECTONS. COMPETE DRAWING BIFLFOW. <br /> TIRE:_ I.., �- DATE:�7 '4�i!! <br /> i <br /> ROT PUN DRAW TO SCALEI RCALf Ip <br /> 1.(MMES OF STILETS OR AOADS NEAREST TO ON BOUNDING THE PROPERTY. R.LOCATION OF HOUSE SEWAGE DISFoBAL SYSTEM OR PROPOSED <br /> 2.OUTLINE OF THE PROF"".%IITH OMSw11 HS AND NORTH DIRECTION' EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> �. oNoft0NTD OUTLNES ANO LOCATION OF ALL EXISTING AND POPOBED STRUCTURES, B.LOCATION OF WD I R WTR11N RADIUS OF ONE HUNDRED TUFTY Fr.ON <br /> DICIUOMO COVERED AM"SUCH M PATIOS.DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOMB 40 PIDPRTY. <br /> c \ <br /> I. <br /> -'Zs <br /> SK <br /> .� ................. <br /> %J'\ <br /> r• Nviao"`EM T EA(rri �s. <br /> A <br /> • A�N bl310h <br /> /} �1�J��, ,�R oEPARTuwr uBB ONLY <br /> APPLICATION ACCEPTED BY 1, I/��( ,(/{` Q GATE' <br /> TANK,PF OR BUMP RFSFECTOII BY DATE I I FINAL tNWECTTON eY� VATS [ <br /> ^ GJ d 12 <br /> O <br /> ADDINALCOMMVI<5: TryWK I�&Wi6'l A W I- <br /> ACCOVNTIPM ONLY: ADE FAC! <br /> R CGUE FR wF0 AMOINT RISSITED Cl ASH IECUVTO s', DATE M(P9WET NU/i!1 INYDIC! II <br /> l L 1 <br /> Pub.H@&"SSrv.•Enviro,174(3196) <br /> IA <br />