SU0005979 - Laserfiche WebLink

Home Browse Search

APPLWOR LIQUID WASTE PERMIT bA COUNTY PUBLIC HEALTH SERVICES 4�'A, ,,,; •, .'ENVIRUNMENTALHEALTH DIVISION " QZS`It�s} `L� Q.��7f368,.304ST WEBER AVENUE, STOCKTON, CA 95201988 489 420 �jREF NDA LE PERM TQEXPIRES3I YEAR FROM DATE ISSUED IComplofa in Tripliaatal APPLICATION IS THEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOW DESCRIBED, THIS APPLICATION IS MADE IN COMPIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 8-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESS/OR APNI ✓P//�y_M,Jn E0 Y �/4,n G CFFY {/�—J,Q7— Z�.Z- LOOT SIZE„ OWNER'S NAME m,p a,-z ��ll ��Tk r, ADDRESS S �7 I 1 PHONE 6Lr-OLt /J CONTRACTOR CD k� ` ,C ADDRESS 1aR.SI r��_ \1\�J LIC/ RHONE 3AFS� nA� SUB CONTRACTOR AODRE66__T____ _LIC# PHONE TYPE OF SEPTIC WORK: NEW INBTALUTION ❑ RPEMAIAODITIOW ® DESTRUCTION ❑ INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILARLE WITHIN 200 FEET OF BUILDING.) T W rAPdlosUan I INSTALLATION WILL SERESIDENCE[JK COMMERCIAL ❑ OTHER ❑ NUMBER OF UVINO UNITS: NUMBEROF BEDROOMS! �� NUMBER OF EMPLOYEE”. CHARACTER OF SOIL TO A DEPTH OF 3 FEET:-1^m .1.,1PHT/SUMP SOIL CHARACTER:!5AdN-4_lly WATER TABLE DEPTH SEPTIC TANKIOREASE TRAP ❑TYPE/MFO CAPACITY NO.COMPARTMENTS _ PRO TREATMENT PLANT ❑ DISTANCE TO NEMEIlT: WELL FOUNDATION PROPERTY LINE UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR HENCLOSED SYSTEMI LEACHING UNE ❑ NO.L LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PPAPERFY LINE SEEPAGE NTS ❑ DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION M PERTY LINE SCRAP& (Y}WIDTH --4N 1( LENGTH DEPTH DISTANCE TO NEAREST:WELL 'SC)' FOUNDATION /Q PROPERTY UNE /17 H DISPOSAL PONOS ❑WIDTHS LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION FIWPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOO(WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,ANO RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'6 HIRING OH SUB WORKMAN'S CONTRACTING SIGNATURE THE CERTIFY THAT IN THE PERFORMANCE OF THE FOR FOR WHICH THIS PERMIT IB ISSUED,I SHALL TNG BE PERSONS SUBJECT 10 WORKMAN'S COMPENSATION e F CACHED A' THE PPUCANT MUST CALL 24 NOIAIS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW, SIGNED (JLl TITLE:_M6 6,vt< S=L.DATE) PLOT PLAN(DRAW TO SCALE)SCALE_ 'to 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. /. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED T 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. �\ 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. I r I R I _Aa;Q. I ? yMOO-, t �s ,s,,Me 8 9 J U L 1 y99� i oAN joAUUIN GDUNTI' PUBLIC HEALTHSEgVICES '�:'vVIRC>unn"ery t FOR DEPARTMENT USE NLY ME ,��/Q�� PLICATION ACCEPTED BY T y_�/ � i�✓ /� OAT __•Z��/'__�__-� AREA: TANK,PIT OR SUMP INSPECTION BY DATE / / FINAL INSPECTION BY DATE / I 3 I 5 ADDITIONAL COMMENTS: ACCOUNTING ONLY: AID# FACT PE CODE FEE I AMOUNT REMITTED C CBI ASH RECDVED BY DATE M I PERMIT NUMBER INVOICE I `FLIv I � C}CD 09