Laserfiche WebLink
APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> R. ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,446 N.SAN JOAQUIN ST.,STOCKTON,CA 96201.0388 <br /> (209)468.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> eR� ICemplete m Tripliutd <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANO/OR INSTALL THE WORK DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-`1111110.3 AND THE STANDARDS OFF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDRESSOR APN/ : �� J L�:)45 ND`"V (— CITY �SC� `1 LOT SIZES L, <br /> /IADDRESS SRNL-L— PHONE <br /> OWNER'S NAME �1 ���T <br /> a CONTRACTOR -^ LJJ..� ADDRESS ''7 S�L•n/.! L/7 LICt <br /> PHONE <br /> /: tZ ..J- <br /> SUB <br /> NJ <br /> SUBCONTRACTOR Ltco471JY1— <br /> YPE <br /> YS� <br /> OF LEFTIC WORK',` NEW I..T.UATION}H REPARVADDITION❑ DESTRUCTION❑ <br /> IND SEPTIC SYSTEM PERMITTED IF PVeI IC SEWER IL <br /> IS AVAABLE WIf IIIN 200 fk ET OF BUILDING.) <br /> FERC TESTI..I I HOW MANY <br /> m APdlo.d. <br /> INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL❑ OTHER❑ <br /> NUMBER OF LIVING UNITS: I NUMBER OF BumooMi:_3 NUMBER OF EAPLOYM: <br /> CHARACTER OF SOIL TO A DEPTH OF J FEET: SA Nn PTT/SUMP SOIL CHARACTER: WATER TABLE DEPTH �I <br /> SEPTIC TANK/GREASE TRAP ®TYPE..'MFG /f/t l �� ./[}tCAPACITY /7l1 EN NO.COMPARTMENTS L+ <br /> 7 <br /> IWO TREATMENT PUNT❑ DISTANCE TO NEAREST: WELL-4z2—L— FOUNDATION S PROPERTY LINE <br /> LIFT STATION❑ SIZE TYPE OF PUMP �/SAND OIL SEPARATOR IENCLOSED SYSTEMI n' <br /> LUCIeNO UNE [3 No.i LENGTH OF LINES Z /Q F DISTANCE TO NEAREST:WELL- /may] FOUNDATIONS PROPERTY LINE /�J <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL <br /> FOUNDATION PROPERTY LINE <br /> SEEPAGE HTS ❑DEPTH SRE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS Of THE SAN JOAQUIN COUNTY.HOME OWNERORLK:ENSED AGENT'S SI THE FOLLOWING:'I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FORWHICH OE <br /> THIS PERMIT IS ISSUED,I SMALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> SUB co SIGN URE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO <br /> YJOR%MAN'S COMPENSA ON LAWS OF CAUFOFNUI.-THE APPUCANT MUST CALL 14 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. p L� <br /> TITLE: � (,''✓t Su.i+ DATE: <br /> SIGNED% <br /> POT RAN(DRAW TO SCALE)SCALE <br /> IP <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. LOCATION Of HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSEDRTY. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> Z.OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> S� 3.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING ANO PROPOSED STRUCTURES, THE PROPERTY OR ADJOINING PROPERTY. <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. L�.. <br /> pAYMENT <br /> JUN 2 9 1995 <br /> in" <br /> 91 <br /> 0 <br /> r <br /> Lla � <br />