SU0005354 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERMI'�- Su SAN AN COUNTY PUBLIC HEALTH SEM-251 .MYIRONMENTAL HEALTH DIVISION P.O.BOX 388, 445 N.SAN JOADUIN ST.,STOCKTON,CA 952010388 (209)4683420 MON REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED ICompl.0 In Tfl herb) Application is hereby aside to the San Joaquin County for a permit to construct and/or Install the work described. This applicatior is rode in compliance with San Joaquin County Development T/1't�Le, Chapter 99�J-''1110.3 and{{sheS//A,arpwlards n of San Joaquin County Public Health Services, Environmental Health Division. aG v/� ^OiQ d,rtr'¢' s /W' Job Addre¢ or APN DOS-030-b3 �'O'/77� 005-O cjb - S City 14Z14-71"0 Lot Size owner's Name A-rrn+. ro si<„n mf.c^n£C Address X1711 N. E<<.orr /+9 A ++aro 9Si�-o Phone EPv 73Z' -� '; 4 '7 TCT 2 Contrector/✓f,� p. /1,64ra.v +yQPzec Address 21 N. Nem.n-r i-N y <anr� LIcA' YYbr 9 Phone 947- Po Sub Contractor - Address Lich `, Phone TYPE OF SEPTIC WORK: NEW INSTALLATION 11 REPAHWAODITION L I DESTRUCTION II FERC TESTM Na� (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) / ` Land Use ApiWtba f Installation wfit serve: Residence_ Camercial_ Other_ Number of living unite,_ Nuibsr of badrooron_ Nuala, of snpl cyssu_ Character of toll to • depth of 7 feats PIe/Sump Soli Character: Water Table Depth SEPTIC TAIYIONEASE TRAP 11 Type/Mfp CepacltY No. Cmpartmenta_ PKO TREATMENT PLANT [ ] Distance to nearest: Well Foudation Property fine LIFT STATION[] Size_Type of Pulp_Sard OIL Separator (enclosed system) LEACHING LINE IT No. S length of tines Distance to Nearest: Nell_ Foundation_Property Lime FILTER BED p Width_ Langth_Depth_ " " Well_ Foundation_Property Lire_ MOUNDED [] Width_Length_Depth_ • ^ Well_ Foundation_Property Line SEEPAGE PITS 0 Depth_ Size_ Number " " Well Foudation_ Property Line ^ SUWS ❑ Width_ Length_Depth_ • Well_ Faadetion_Property Line DISPOSAL PONDS ❑ Width_ Length_Depth_ " • Well_ Foudatim_Property Line 1 hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances and State Laws, and Rules and Regulations of the San Joaquin Canty. Hone ouner or licensed agent's signature certifies the following "1 certify that in the performance of the work for which this permit is issued, 1 shaLt not mpLoy any person In such a manner ash to becoe, subject to workman's carpensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persona subject to workman's compensation Laws of California." _ The y,West nal bus b do pWrM Ingmdam. Complete drawing be lou. Signed G- Title:P2E3aJ8-ri Data: /-Z/. 7 . PLOT PLAN (Draw to Scale) Scats_" to i. sows of streets or roads merest to or bonding the property. L. Location of house sewage disposal system or 2. �ou,itna of the property, with elmetal one and North direction. proposed eapwion of sewage disposal systems. 3.. Ofsomfoned out Lines and location of Ali existing and proposed 5. Location of wells within radius of 150 ft. or structures, including covered areas such as patios, driveways, the property or adjoining property. and walks. el L (= 1-e 7- T-A Y Apr. P I3L.1 ldE. LTIJ IFR CES FOR DEPARTMENT USE ONLY //11 // G�( 96 Application Accepted by S��A� Date- /7 Area: rc.I CO'0 Tank, Pit or Sump Inspection by Date / / Finsl Inspection by*t.F/2pn*,p a,', Date Additional Comments: ACCOUNTING ONLY: AID# FACN PE CODE FEE INFO AMOUNT REMITTED HE RICASH RECEIVED BY DATE SRI PERMIT NUMBER INVOICE/