Laserfiche WebLink
I. APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 95201388 <br /> i. 12091 488-3420 <br /> NON REFUNDAIRLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> IEbRRbM M 761,6BAW <br /> APPLICATION 18 HEREBY MADE TO THE SAN JOAC1 COUNTY FOO A PERMIT TO CONSTRUCT ANOME INSTALL THE WOW OEBCMOPo. THIS AR AT10N 16 MADE IN COMIV ANC&WITH SAN <br /> JOAOUIN COUNTY DEVELOPMENT TITLE.CHAPTER 8-1110.3 AND THE STANDARDS OF BAN JCAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIPCNMENTAL HEALTH DIVISION. <br /> r JOB ADDRESSOR APN • r"A` -At - CA, Q.M✓h LOT BILE <br /> OWAGUTA HAMS )!,- ADDRESS Ls _ PHONE <br /> CONTRACTOR ADEERESS in JLI >.l bwjJ...,,.� /xt LIC/ eil ..•r PHouE' Y-G-4:Z'7 <br /> r SUB CONTRACTOR AOONEN. /ICI PHONE <br /> TYPE OF SEPTIC WORN: NEW INETALLATON❑ BWAIIVADdTOM E3. OEATRUCTIOX❑ <br /> NO SEPTIC SYSTEM KRMITTFD IF NBL1C SEWER IS AVAILABLE WITHIN 300 FEET OF BVIIDING.1 FRED TtlThl I I HOW MANY <br /> BOBINATAUATON WILL INAW%, RESIDENCE M CMNMEICIA1.❑ OTHER❑ <br /> .VAS.OF UW.UNTIE: y XUTASd OFem1100MY BURNHAI OF EMPLOYEFJ: <br /> CHARACTER OF 6dL TO A ARM OF J FEET: RTNJUP SORT CHARACTER: WATERTABLF DEPTH r <br /> AFPAG TA....E TRAP ❑TVAMFO CAPACITY NO.COMP.NIGHTB <br /> ROSSI PCO TRF/.TMMT PANT❑ dSTAXCE TO BROOME: WELL FOUNDATION POPERTV UNE r <br /> IST RATION❑ GQE TYPE OF PIMP BAN.OIL SEPARATOR(ENCLOSED SYSTEM) C <br /> LAUGHING,CLAUGHING,UHANDS Iv NO.\IFNGTN BE )-i(rOIR <br /> ' ANCFTO NrtR <br /> FA :WELL-/51�`PoUNDATEN /.'0 PICFEpry LINE �p(� <br /> PRIERRO ❑MTDM UNNAI DEPTH MSTANCE TO NEA EBT:WELL MCONDUATION PROPE1 IME <br /> r MOUNDED ❑WIDTH LENGTH DEPTH_DISTANCE TO NEARER:WELL FOUNDATION_PROPERTY UNE <br /> AFVAOE IrtS FI' DEPTH GONE &, NUMBERJ_d6TANCF TD NEAPFeT:WELL�Q_PoVNOATON hY: PCPERTY IIHE .%C� F <br /> SUMPS ❑AGE" IFNGTH DEPTH_W RTANCE TO NEARER:WELL_FOUNDATION PROPERTY LINE <br /> d6PoEAL MHOS ❑WOTH LENGTH DEPTH dRANCE TO NEARER:WELLFOUNDATION PROPERTY IME <br /> PASS I HEREBY CERTIFY THAT I HAVE PREPARED <br /> THIS APRICATON AND THAT THE WOW WILL BE CONE IN ACCORDANCE WITH SAN JOAGUIN COUNTY ORDINANCES AND STATE LAWS AND RULES <br /> AND PEGMATNONS OF THE SARA JOACRAN COUNTY.HOME OWNER OR LICENSED AOERM 8 SIONATURE CERTIFIES THE FOLLOWING:'I CEMIFYTHAT M THE PERFORMANCE OF THE WOW MR WHICH <br /> THIS KAMM IB ARGUED.I SHMl NOT EMPLOY ANY PRO SOH IN OUCH A MANNER AS TO BECOME BUBJECTTO WOR[MAN'6 COMPENSATION LAW.OF CAHFORNM.' COMPACTOR'S HIRINO OR <br /> SUB{ONTPACTINO SIGNATURE CERTIFIES THE FOLLOWS";'I CIUCHPYTHAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IB ISSUED 1 SHALL EMROV IERBON6 SUBJECT TO <br /> WOMMAN'B COMPENSATION LAWS <br /> Of CCALSADAMATHE APPLICANT MUST CALL SI POW IN ADVANCE FOR ALL REQUIRED INSPECTION&. COMPLETE ORAWINO BELOW. <br /> NO <br /> r ENEO N a //O_L TRUE: SZ- .ATE: <br /> PLOT PLAN OMW TO SCALE/SCALE <br /> 1.NAME.OF RRERR S OR AGREES NEAREST TO OR SOUNDING THE PROPERTY. A LOCATION OF ROUSE SEWAGE DISM.M.SYEMENI OR P OPORM <br /> E. (AM-NIS OF THE.1,WITH OIMENBIONB AND NORTH INFECT... EXPAN6ON OF 6EWAOE DI.KA A-SYSTEM.. <br /> ]. DIMENSIONED OUTLINES N.LOCATION OF ALL F%IRINO AND REPOSED STRUCTURE.. 6.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> r INCLUDING COKRED AREM SUCH AS PATIOS.DRIVEWAYS,AND WAAXA. THE WANRRY OR ADJOINING PROPERTY. <br /> POR <br /> r DODO v� <br /> Nov <br /> ASAP _. <br /> FOR IFPMTMENT UAE DXR <br /> BROPNRICATIONACCEPTED BY [ .ATE: ///� �(/I gREA: Z( ZI <br /> TAM.,FFrJ R BUMPINSPECTION BY GATE ( // FINAL INGPECTON BV���?a� /!P"7 DATE//I/�/ <br /> AOORIONRL COMMEMB: <br /> ONLY AIDE FAC/ <br /> ZEBEIRM <br /> AMOUNTRWI EXEC AB FL BVEO BY OATf N/PNEAIT MUM091 INVOKE/ <br />