SU0002216 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERK . SAN JOAQUIN COUNTY PUBLIC HEAL,-f1 SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209) 468-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (Complete In Trlplksta) ArTIICATK)N le IIFr1FRY MADE TO 711E RAN JOA0111N COUNTY FORA FF"MIT 10 CONRTFIUCT AND/On INSTALL TIIE WOOS(DERCRRFO. 71114 AMICA1roN 18 MADF IN COMPLIANCE WIT/1 11/ JOAQUIN COUNTY DEWO-OMAENT TITLE,C1/APTEn 8-1/1 10".3 AN" E BTANDAROS OF BAN JOAO�/ILJ COUNTY PUBLIC IIEALT RFnV10E8.ENVIDONMFNTAL IIEALTII DIVIRK)N, Q�/ `r JOB ADOnfea/o J/ 1..� !" ((_f _city U Lor AM OwrlFn'R NAME o— fI AOo11FPP `"7V L -•�E:Zn�� ,t��• nroNF -AOCl/ CON I MC T On AD011F R R----III LPC I P11011F RUB CONIMCi On ADONRR tic PIONF TYPE OF PFrTIC WORK! NEW INNTALIJITION nErAIR/AnO1TION ❑ nra TnOCTION r IND PEPTIC RYBTEM rfr%AI TFO IF r UBLIC REWEn 18 AVAILABLE W11/11H 20o FFFT Or RUILMN0.1 /\ PERC TEST(.)1 1110W MANY ` , APoeard— E INSTALLATION WILL SETTVE rtFR1UFNCE{!LI COMMERCIAL ❑ ottirn ❑ NUPOIN4II OF NVINO UNITS_ NI1MRFR OF BFOROOMS• �L— NUMRM OF PAMOYFF.B: _- CIIAMCTfn OF r.011 TO A DEMO Or I FEET: MT/RUMP FOIL CHARACTEn: h ATFR TARIE OFPT11 SFPTIC TANKX)REABE TRAP PrTYPE'IMfOaA- CAPACITY I1 �D NO.COMPART MFNiR R(O TRFATMrNT PLANT ❑ MSTANCE TO NEAREST! WELL rOUNOATR)N /I'f1OPEn1Y LOW LIrT STATION ElC17E TYPE OF F11Mr—[�y��—/-RANO OIL 11F.rAnATOn IENCtoPFn BVRTTMI 404' `` / tFACISNO LINE ❑ NO.•IFNOlIi Or LINER / DIRTANCE 70 NEAMPT!Wr11.1C / fOIINDATK)NP1K)PFRTY 11NF FILTER■f0 ❑mirriv LENnTII DEPTH DIPTANCF TO NEARFRT:WEIt TOUNDATION PLOPfntY UNF MOUNDED ❑VJIDTII LENOTII DFrTII (� INSTANCE TO NEAREST:WELT. FOUNDATION 1470PEn1Y LINF_� SEEPAGE MTB ❑OEPTN—j NZE Ste_NUMBER / DISTANCE 10 NFARERTI WELL FOUNDATION_PnOPFRTY LINE _� S1RWrS ❑LMom LFNOTII DEMO —T'—rNPTANCE 70 NFAnf RT:WEIL FOUNDATION P PPF"Y(ONE DISPOSAL PONOS ❑W10111 LFNOTII DFPTII DIRtANCE 10 NFAMPT:WEtI F0IINOA110N P"OrInIY IINE 111r11EPY CFRTIrY MAT 1 NAVE mrrARfO TIIIR APYICATION ANO MAT TIIE WOM%MI L RE DONE IN ACCOnDANCE WITH PAN JOAQUIN COUNTY OMINAM-7FA AND RIATE LAWS,AND nUIF9 ANOMOULATIONS OF TILE RAN JOAOUINCOUNTY.HOMEOWNFn ORLICENREO AGENT'S RIONATURE CERTIFIES TIIE roLLOWINO:'ICERrIFY THAT INTHEPERFOMAANCE Or 711EWOIIKrORW111C11 TIIIR PEl1MtT IN IRRUED,I 014AIL NOT FMROY ANY PER80N IN OUCH A MANNFn AR TO BECOME 8118JECT TO~~MAN'S COMr4NSATION LAWS OF CAIIFORMA.- CONTMCTOn-P IIIrdNO On PIIS CONTRACTIFIO mONATURE CF/TTIFIER T FOIIOW_INO: '1 CERTIFY TIIAT IN T14E PFnrOMAANCE of 711E Worw ron VVIIICII Two PERMIT 10 IRRUEO.181IATt fMMOY rfnPONR RLIPJECT 10 W MMAN'R COMPENRATION LAVy OF C LIFO IQ APPLICANT MUST CALL 14 HOURS IN ADVANCE FOR tALL REGURIED INSPEC110NS. COMFLE7E MIAW,NO BELOW. PIO►IE % TITI.F (�.T-C�`' DATE• •� �° ('(' MPLAN AN IOnAW TO SCAIFI BCALF_ In i. NAME*Or BTFV E78 On nOAD8 NEAREST T ROUNMNO TIIE FTIOPERTY. 4. LOCATION OF 1101111E PFWAOE D MIIAL RYBTEM OR PFIOPOBFD 7. OUIIINF Of TIIE PROPERTY,WITII DIMEN*,ON8 AND NORTII DIRECTION. EXrANBroN OF REWAOE DIPPOBAL SYSTEMR. 3. DIMFN81ONF0 OUTLINES ANO LOCATION OF ALL EXI*IINO AND rnol"OREO STRUCTURES, G. LOCATION OF WELL*WITHIN FIAINUB OF ONE 17VNOnFD FIFTY FT.ON INCLUDING COVERED AREAR BUC11 AN PATIOS,OIVVEWAYS,AND WALK8. THE P10r mTY OR ADJOINING"Iffff". -- c — A00 — . . AR 5 1999 EY I .S T I KI (t ron nFrATnTMrNT IISF ONI Y 1 TN Arri.Iq ATION ACCFF-TFO BY / - � ' DATF• ARFA:" )/� 111+ OF �/—I �!A i� L AN��[J` onNL1MrnJRPFCTIONRV G� nwe —� DATF '�L�„/:C ltAI INnr-FC71oNRY I DATE / / ADfHiroNA�OMMENT 11• �- _[—`.J.! �_ !7 _ __ f 61 k ACCOUNNNO ONLY: 1 AID/ M CODE. Fri.Wro AMOUNT R"I TFD IIfCKI 211 nrcrrVFD NY DATE SII I rFr"T NUMBER INVOICE I � L6 Pub.Health SPIv.-Envlro. 174(3/9(;)