Laserfiche WebLink
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 9S201388 <br /> (209) 4883420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> mplaut <br /> fripl <br /> APftKATION IS HEREBY MADE TO THE 9/LI/JOAQUNCOUNTY FOR A PERMIT TO COCNSTALICT ANDIOn INSTALL THE WOW DESCRIBED, THIS APPLICATION It MADE IN COMPLIANCE WITH RIM <br /> JOAOUN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOVIN COUNTY PUBLIC HEALTH SERVICES,ENNRONMEWAL HEATH DIVISION. <br /> JOB ADonEeeronAPNF _7 7G'G 1 (_. h , / <br /> PTY C/r Lor s� . G1At2>,, <br /> OWNER'S NAME I(ih �1-LQ��� e/U <br /> J <br /> cONTMcron.�ti: - �' � •1r ADORES ,i Z i E. Ck we lil/ S''tL r —PHONE -7 Y(� <br /> BUB <br /> CONTRACTOR <br /> uc[ Y LZ • PHONE tllo� 5 3 Y 3 <br /> ADDRESS <br /> LACI y <br /> TY►[OF BERING WORK: NEW INSTALLATION ❑ ••'••^c��� <br /> 11F►AMHAODITIOOL'1TRUCTON ❑ <br /> PHO SEPTIC SYSTEM PERMITTED F PUBLIC SEWER IS AVAILABLE WTTNN ZW FEET OF UILDIN0.1 <br /> PBLC TDITbI l IN"ALANT <br /> APPllweon• —�— <br /> INSTALLATION WILL ,WE: RESIDENCE COMMERCIAL ❑ OTHER ❑ <br /> MAABq OF)MNG DMT[: - NUMBBII Of B®1100M[:� <br /> NIALN61 OF BMROYEEB: <br /> CHr R OF 60R TO A DEPTH OF J FEET:,C/ <br /> �'+ ,a¢I�-�� PLT(SVMP SOII.CHAMC �''�- ,/J/"C_g��/J <br /> L T BE TRY ❑TVFEmr- �R:t WATER TABLE DEPTH�—� \ <br /> p TA,ATMOIT P1/111T❑ UISTAMC[TO NEARLY: WELL,2(y7iT �" L „ZtxJ 7'G NO.COMPARTMFM[ <br /> t FOUNVATKIN ,ti PAOPENT'LALE lec-H �— (' <br /> 1/T STATION❑ BRE TYPE CF FVPAP (` <br /> LL���.A��1� CIL SEPARATOR)ENCLOSED SY8TEM1 <br /> I TORbemmm LIN[ �wroia LENGTH Of LINES-/`=1=77—z <br /> KTDI SED DISTANCE TO NEAREST:WWELI=ELe—r FOUNDATION <br /> IENOTNIDEQ DISTANCE TO �PROPERTY LANE a 66 /4- <br /> NA�NDED ❑WIDTH LENGTH MEANEST:WELL FOUNDATION PROPERTY <br /> DEPTH DISTANCE TO NE LINE <br /> EEPAGE NTS �ipEFPH '� ' [� �` �. NEAREST:WELL FOUNOATION PTOPERTY LINE r <br /> NUMBER / DISTANCE TO NEAREST:WELL :n T1 <br /> WM ❑WIDTH IENOTNFOUNDATION AOPT1Ty LAI, K <br /> "NUM, •f' <br /> IfFOeA "NUM, 13WIDTH <br /> DEPTH DISTANCE TO NEAREST:WELL WRVTH FOVNpATION PROPERTY LINEDEPTH DISTANCE TO NEAREST;WELL <br /> FOVNpATION P110PF/ITY UIIE <br /> `o FeEl CERTIFY THAT 1 HALE PREPARED TWO Y.HOW OWN ANO THAT THE WORt <br /> ND IEWAA IS 1 OF THE SNL JOAOIIN WILL K DONE M RT,,O9 ,,R WITH <br /> SML JOAlR1M1 COUNTY ORONANCES AND STATE LAWS,ANp RtULES <br /> P,S COUNTY.RPERSONOMEO WNSUOR EN/EO AGENT'B NONATURE CERTIFIES TINE FOLLOMANO:•I CERTIFYTNAT N THE PERFORMANCE OF TII .W FOnWI us <br /> ISI ED,I WALL FRT OWING N SUCH ANNER AS TO BECOME SUSJECT TO WOIRmAN'S COMPEINM <br /> OMnACTINO E LLONRM{; •1 CE TON LAWS SOFOC, CO <br /> R(MANY COM TON T N THE PERF, MANCE OF THE WORK FOq WNIOH TMG PERMIT IS[Me <br /> eeSUFO.I WALL NTMCTOR'S HPSMNO OR <br /> IA' K AFPU T M CALL Be wotAv IN ADVANCE FOR ALL EMPLOY PERSONS SLSJECT TO <br /> R[q�REp WSM,,,NS. COMPLETE ORAWTIO BELOW. <br /> INFO% //f <br /> 1 TYLE: \ 4t n DATE: <br /> PLOT RAN(DRAW TO SCALE)SCALE T <br /> WROOVNAMIEG OF Ono <br /> OLRLK T4 TO OR BOUNDING THE PROPERTY. <br /> RLOFERM WITH DISSENSIONS AND NORTH DIRECTION. t. LOCATION Of HOUSE SEWAGE DISPOSAL SYSTEM On PROPOSED <br /> OIMENSO/�0UEISI[B ARO CATION OF ALL EXISTING AND PFRIMUO STRUCTURES, EXPANSION Of SEWAGE DISPOSAL SYSTEMS. <br /> NCLUVNB LbMEI�D AIIFM[IICIILON PATIOS,DITPAIWAYS,AND WALLS I. LOCATION OF WELLS WTTMN RAMS Of ONE HVNOPEp FIFTY FT.ON <br /> THE PROPERTY On ADJONINO PROPERTY. <br /> {eta 3cicti "' <br /> I � - <br /> I <br />