Laserfiche WebLink
APPLICATION FOR LIOUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SeflVICES <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 /> (CGIn►IFL@ M TrlpRi@b1 <br /> APRICATION 18 HEREBY MADE TO THE BAN JOAWIN COUNTY MR A PERMIT TO CONSTRUCT ANOMR INSTALL THE WORK DESCRIBED. THIS APRICATION 18 MADE IN COMP IAME WITH SAN <br /> JOAOUIN COUNTY DEVELOAAENT TTILE•CHAPTER/-1110.3...111 AND THE STANDARDS O'F,"BEAM"AWN COUNTY MOM HEALTH B(/FL�RMEG.EHVIIgN1 AL HEALTH dVMpN. <br /> JOB ADDRESSMA A# > /S R/L � CITY LOT MZE � <br /> OWNER'.NN.1E`�L) �/ � ' ADDRESSPFIONE7y� -8sir <br /> CONTRACTOR--,4,'"1 7 TC7LM 4 ADDRESS UCI ��J PHONE �!(v3 C3 <br /> 6VB COMPACTOR AO011E66 LIC' ATONE <br /> TYPE OF SETING WOW NEW INSTALLATION REPAdIAOdt10M ❑ DFtTAMMN ❑ <br /> INO SEPTIC SYSTEM PERMERED IF RIBiIC SEWER 18 AVASABLE WNHIN 100 FEET OF BUILDINO.I PERK TESTIH 1 1 HOW MARY <br /> AFPLaWen I <br /> IMETAlL11RON WILL fBNE TFSN)ENC COMMERCIAL�EP <br /> UMIPNM ❑ <br /> NWRER OF LIVING TS:_ SUI OF SEIMOOMS: NLIMRER OF RMrtO/YEEI: E <br /> CI AC <br /> /1A���\YETI lR 60R TO A DEPTH OF]FEF( QI'L PTT/BUMP 601E CMAMC'TEIE` iFE WATER TA2LF DEPTH CJ /� <br /> /IEyTIO jARILOREASE TMP ❑T Ffl ' C. C�kiuELL RQ� CAPACITY NO.COMPARTMEN .-T/. 122 <br /> MO T11E1UMfMT RANT❑ DISTANCE TO NEAHEAT: W1F � PEUN <br /> b MUNDATION I PRORTY E I <br /> UFT STAMM❑ GI E TWE O�FF�YFwP SAND OIL SEPARATOR(ENCLOSED SYSTEM( <br /> LEACHING MELNO.i LENOTH OF LMEBd� In�, �f I'LJ-yi dBTANCE TO MEANT":WELL OIC" MMNOAMN�_PRVKRTYIME <br /> FRTEA SED (❑Ji WIDTH IFNOTH DEPTH pBTAME TO NEAPEe(:WELL FWNDATON PROPERTY LANE <br /> MOUNDED 0 <br /> TT1 MDT" ` LLNOTH DFJ'fH DISTANCE TO NEAREST:WEIl Q TOUNOATgN PIgfIJUY IME�� <br /> SEEPAGE MTS DEPTH7J SRE�M OER=DISTANCE TO MAROT:WELL'�dFOUNDATIONS_R10MRTY(MEI f <br /> own ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION FRORMY UNE <br /> DISPOSAL MMDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLMMDA N PROPERTY ME <br /> I HEREBY CERAFY THAT 1 RAVE PREPNED THIS APPLMATION ANO THAT THE WILL M TAM M ACCORDANCE WITH SAN JOAUUIN COUNTY ORDINANCES AND STATE LAWS.AND RUILES <br /> AND IE(I"MNS OF TMSAN JOApNN COMITY.NONEOWHERORMENS HE'S MONATLRRE CERTNIESTMwLLOWINO:•ICERTIFYTHATMTM FERFORNIANCE OF TIE WORK wRWIECH <br /> THIS PUYAT I8 HISUEO.1 SHALL MOT FlIFLOY ANY N M SUCH A M R TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAI/MINA.• COMRACTOR'B IIIRIIIO OR <br /> SU CONT MGNA CERTIFIE wLLO I CERTIFY TH M T E PERFOM1ANCE OF THE WON(FOR WHICH THIS MANGY IS MISLED.I SMALL ENI IOY PERMING SLIM TO <br /> M:IMM S COM IN DN a MESA. E 24 NOW IN ADVANCE FOR ALL <br /> MO INSMMNf. COMPETE plAW11q 9EIAW. 9 <br /> SMNED TALE: \1V` DATE' / <br /> .. Lor 0.A(NDMW TO SCALL(SCALE_ •le <br /> 1. NAAIE8 OF STREETS OR ROADS NEAREST OR DOUNOINO THE MIOMFITY. 4. DOCATION OF MUeE SEWAGE dOOGM SYSTEM OR FMM$EO <br /> ]. OUTLINE OF THE FEOFE .WHIZ DIMENSIONS AND NORTH DIRECTION. EXPANSION OF GEWAOE DHIMSM KelTNI. <br /> O. DIMENSIONED OUii1RE@ AND LOCATION OF ALL EgSTINO AND PROPOSED STRLICTNES. E. LOCATION OF WELLS MITHIN RADRIS OF OM HUNDRED FIFTY FT.ON <br /> .- INCLUDING <br /> COVERED MFA@ SUCH AS PATIOS.pSVEWAY9.AND WALXG. THE PMOFERTY OR A0.10NNG PILpiRTY. <br /> T _. • ��// <br /> W <br /> SEP 31998 <br />