Laserfiche WebLink
APPLICATION FOR LIQUID WASTE PERMIT �i�C�571 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (Complbt$in TTipikatb) <br /> APPLICATION 18 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPUCATION 18 MADE IN COMPUANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 8-1110.3/AND <br /> THE STA O 8 OFF/S JO IN COUNTY PUSUC HEALTH <br /> SSERVICES. <br /> ENVIRONMENTAL HEALTH DIVISION. ^' <br /> JOB ADDRESSOR APN/ n / / / / Y � �/ �I- , CITY !/ wLiC-✓/L I• LOT <br /> /SIZP�/� <br /> OWNER'S NAM F v_ f��L�[iry�J ADDRE53 /J`n L c PHONE N <br /> CONTRACTOR ADDRESS (� (_/Lu/t��1 // !, L1CI �- PHONE - <br /> SUB CONTRACTOR ADDRESS LIC/ PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADOITIO DESTRUCTION ❑ <br /> ANO SEPTIC SYSTEM PERMITTED IF PUBUC SEWER IS AVAILABLE WITHIN 200 FEET OF UILDINGJ PERC TESTI.)I I HOW MANY <br /> Appbostlon <br /> INSTALLATION WILL SERVE: RESIDENCE 11COMMETK�OTHER ❑ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF S IA v' . tSUMP SOIL CHARACT 1 A TABLE DEPTH <br /> SEPTIC TANK/OREASE TRAP ❑TYPE/MFG CAPACITY NO.COMPARTMENTS <br /> PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM) ¢- <br /> LEACHING UNE �NO.a LENGTH OF UNESA6 D4L 41, �.a'f DISTANCE TO NEAREST:WELL�r.�6ETONDATION/_PROPERTY UNE J O <br /> FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> MOUNDED ❑WIOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> SEEPAGE P1T6 ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION f PROPERTY UNE <br /> /�_ <br /> SUMPS )DTH LD ' LENGTH �Q ' DEPTH �C DISTANCE TO NEAREST:WELFOUNDATION Z-0 1 PROPERTY UNE d ' '4— <br /> DI6PO$AL POND$ ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE RK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> ANrfTISISSUE REGTHE BAN JOAQUIN COUNTY.HOME OWNER OR LICENS GENT'S SIGNATURE CERTIFIES THE FOLLOWING:*1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br /> THII B L N EMPLO ANY PERSON M SUCH A M E AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> SUSIG 1 RE CE FI T E FO OWING:'I CERTIFY AT IN HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> WOENB W8 F C IWIA' THE APPA ►IOURf IN ADVANCE FOR ALL REQUIRED IN6PECTION6. COMPLETE pfMW1N0 BELOW. <br /> 810TRLE: DATE: d <br /> PLOT PLAN(DRAW TO SCALE)SCALE_ 'to <br /> 1. NAMES OF STREETS OR ROADS NEARES OR BOUN04NO THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED OLITUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,ONVEWAYS,AND WALKS- THE PROPEVrY OR ADJOINING PRDPERTY. <br /> .. . <br /> .... ... _ :...��5 <br /> Rz :. ... <br /> .. <br /> /f <br /> ..... .... .. <br /> o _ `:.... .`. .. . ........ <br /> :.....:......<......... �� c. <br /> ...........................:.....;.... .. <br /> L .�.. ............. <br /> Of <br /> UG3 �t998 ........ y...:.... ....:.... ..... _ J <br /> ....:.. :.......;..................:.... <br /> t <br /> SAN JOACIUIN COUNTY 1 ... <br /> :............... .. ... ....._. <br /> ��S}� <br /> '.p(jsuC'HEAff1+sEAv"s............ .. - p <br /> � ) ENVIRONMENTAL.HEALtH <br /> DIV 19ION. ..... . <br />