My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SU0003634
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
P
>
PINE
>
6489
>
2600 - Land Use Program
>
LA-01-83
>
SU0003634
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/7/2020 11:30:07 AM
Creation date
9/8/2019 12:44:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0003634
PE
2690
FACILITY_NAME
LA-01-83
STREET_NUMBER
6489
Direction
E
STREET_NAME
PINE
STREET_TYPE
ST
City
LODI
ENTERED_DATE
5/7/2004 12:00:00 AM
SITE_LOCATION
6489 E PINE ST
RECEIVED_DATE
11/6/2001 12:00:00 AM
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\P\PINE\6489\LA-01-83\SU0003634\APPL.PDF \MIGRATIONS\P\PINE\6489\LA-01-83\SU0003634\CDD OK.PDF \MIGRATIONS\P\PINE\6489\LA-01-83\SU0003634\EH COND.PDF \MIGRATIONS\P\PINE\6489\LA-01-83\SU0003634\EH PERM.PDF
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
22
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
n 'PLICATION FOR 1.1011)WASTE PERMIT -' d <br /> SAN .IUAOUIN COUNTY PUBLIC HEALTH SERVICES � <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> NOR-REFUNDABLE PERMIT EXPIRES I TEAR ROA) DATE 183HO <br /> APP1, Kamp}@(@ lot TrIpRwlBl I? <br /> 'JOA UIN CO N HEREBY MADE TO THE BAN JOAQUIN 9.COUNTY FOR q PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS E IN COMI•LIANC£WITH BAN <br /> h -JOAOUIN COUNTY bEVELgPMEHF TITLE,CHAPTER 0-11 10.3 AND TYLE STANDARDS OF VAN JOAQUIN COUNTY PUBLIC HEALTH BEIWICEB,ENVIRONMENTAL HEALTH bINSION. <br /> ADDREBB/On APNI_ ..... _ <br /> R CITY ,:�_,__, <br /> 3tOT SIZF <br /> OWNER'S NAME �?( <br /> - <br /> � <br /> • <br /> f yAooms r_-. zl 4 , (-1 - <br /> CHONEL — <br /> CONTRACTOR . [� /L� •Y`1�-f1,r./ f hl(r] AbORE88 �! rl )JCI PHONE <br /> BUD CONTRACTOR 'ADDRESS UC/ PIIONF <br /> TYPE OF BEPTIC WORK: NEW INSTALLATION ❑ I REPNRIADDITION _ OWATRUCTTON 0 <br /> {NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 10 AVAILABLE WITHIN 200 FEET OF BILI NG.► P6SC TR7rTl@l 1 I HOW MANY <br /> j ,.,J Applle�tlen / <br /> INSTALLATION WILL SERVE: RE610ENCE 1314 COMMERCIAL © OTHER❑ - <br /> -��NUMBER OF LIVING 1TMTG; - NL BBEFt OF BEDROOMS: NUMBER OF EMPLOYEE@; <br /> �-CHARACTER OF SOIL TO A DEPTH OF 3 FEET; PITIBUMP SOIL CHARACTER! WATER TABLE DEPT <br /> It <br /> iEPTIC TANK/OREASE TRAP 4-fN.}©TVF'E/M _ <br /> FO CAPACITY <br /> NO.COMPARTMENTS <br /> rY <br /> PKO TREATMENT PLANT CI DISTANCE TO NEAREST: WELL 4-.-' FOUNDATION PnoPERTy LINE ' <br /> I1` LIFT 11TAT1ONO SIZE TYPE OF PUMP SANO OIL 8EPARATOR(ENCLOSED SYSTEM) <br /> LEgCI(N4 UNE 0'NO,A LENGTH OF UNE8 - �- 'f DIBTANCE TO NEAAESTf WELT. S U - FOUNDATION PROPERTY UNE <br /> h <br /> ALTER SED D WIOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> - <br /> MOUNDED - E3 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> hEEPAOE PITS ❑OEPTII SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> SUMPS �}WIpTH. ...,. _. L•ENTITH <br /> 1��..�DEPTH DISTANCE TO NEAREST!WELL L] G�,FOUNDATION PROPERTY LINE <br /> bliPOigt IONDB WIDTH LENGTH DEPTH DISTANCE TO NEAREST;WELL FOUNDATION PROPERTY LINE <br /> `Y ' <br /> I(HEREBY CERTfFY THAT I HAVE PREPARED THIS APPLfCATION AND THAT THE vvgrK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNryORDINANCES AND STATE LAWS•AND RILES <br /> AND REOULATiom OF THE SAN JOAQUIN COUNTY.HOME OWNER ORUCENVED AGENT'S SIGNATURE CERTIFIES THEFOLLOWING:it CERTfrYTHAT INTHEPEIIFORMANCE OF THE WORK FOR WHICH <br /> THIS PERMIT 10 ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER At TO BECOME OUBJECT TO WORKMAN'S COMPENSATION tAWB OF CALIFORNIA.- CONTRACTOR'S HIRING OR <br /> 1368•CONTMCTINO SIGNATURE CERTIFIER THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> WRKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOMO IN ADVANCE FOR ALL RICUIREV INSSPECTIONo. COMPLETE pRAWINO BELOW, <br /> 814NEbX TITLE:_L���f1('�'C- DATE: <br /> 777 <br /> PLOT PIAN IORAW TO SCALE)OCALE_ <br /> T N RTE$'OF 8TREET8 OR IOADB NEAREST IG OR BOUNDINO THE rMp[ Ty, 4• LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PTIOPOBED <br /> 2 I OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTFIIDIRECTION. EXPANSION OF 6EWA0E DISPOSAL I Y@TEMS• <br /> 3?DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 5. LOCATION OF WELLS WTFHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> o INCLUDING COVERED AREAS SUCH As PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY On ADJOIFIINO PROPERTY, <br /> GfNA <br /> .. ..... - <br /> .., <br /> .......... <br /> r a 7 7 ...... <br /> .. <br /> i _ h <br /> . - - <br /> T <br /> ...... - - <br /> ......................... <br /> ........... <br /> ......... <br /> ., <br /> . ... ........ .. ... .... .. .......... ...!.i-. <br /> .......... <br /> .. . <br /> .. - .. <br /> .. <br /> .-... .. <br /> ......, .... .., <br /> ................ <br /> ............ <br /> ..... <br /> ......... . ..... . .. ., .. .. - .. <br /> ..... .. ., .. <br /> .......... <br /> ..... <br /> : <br /> ... <br /> I ... � . <br /> ..... <br /> MAR <br /> S Af"AOL. <br /> ` ENVJp{�F H�Q <br /> NMERT,4f.J:GAJ.,ry <br /> .................... ..........,......:.. ..... -...,.........,:.......;......:......,.......:....,:...........,,:-..-,..:.......;......:.......>......E....-.:.:.....i......r....... <br /> •' f FORD ARTIMENT USE ONLY I r <br /> APEUCATION ACCEPTED BY ••1 � � N (_. {`,' Cy 77 - <br /> ,� .. DATE! AREA: <br /> TANKT ,PIT OR SUMP INSPECTION 8Y DATE FINAL INSPECTION BY DATE - J / <br /> J <br /> ADDITIONAL COMMENTS:� � / 1 �,f/�J <br /> i <br /> ACCOUNTING ONLY: AID+ FAC# <br /> 11PE CODE FEE INFO AMOUNT REMITTED 1C}IECKI}CASH RECEIVED BYJ DATE SR J PERMIT NUMBER INVOICE I <br /> _r � � l..l , 47... `171 r_,,- �""f�l�:t�. ���� �f+{�!-[!' I,•.J J '-.;"� J :i � '� <br /> I <br /> Pub.H6aM Sarv.-Errviro.174-0/96) <br />
The URL can be used to link to this page
Your browser does not support the video tag.