SU0006895 SSNL - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 304 EAST WEBER-AVENUE, STOCKTON. CA 95201388 (209) 468-3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete In Triplicate) APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION 19 MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT/TITLE,CHAPTER 9-1110.3 AND THE ST DARDS OF SANJ�OAQQU�IN UNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESSOR APNI C��C,.,J�� , � `�/ Imo• 7 CITY OWNER'S NAME �� f'lf C�G.�•� C(� ADDRESS G �./ ( / PHONE J �- ADDRESS/, � ch44�•CJ'• // ..7�`F i7 'PHONE ��~ .7 CONTRACTOR _ �LC^7T _ LJC/ SUR CONTRACTOR ADDRESS LIC* PHONE r TYPE OF SEPTIC WORK: NEW INSTALLATION f REPAIRIADDITION ❑ DESTRUCTION ❑ WO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AV LABLE WITHIN 200 FEET OF BUILDING.) FERC TESTI.)I 1 HOW MANY ADdloetlon I _ INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL ❑ OTHER ❑ /tom ,g NUMBS"-1,MN0 UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:_ -CffARACYTER OP SOIL TO A DEPTH OF 3 FEET6Ah A L PIT/SUMP SOIL CHARACTER:!!� --L WATER TABLE DEPTH C`\ SEPTIC TANK/OREASE TRAP [ITYPE/MFG�h••LCI-I C� ^-��/ CAPACITY //2c- �� NO.COMPARTMENTS Wl N PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL l F+-'LT '-L- FOUNDATION ` PROPERTY UNE a LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) , er� s � LEACHING LINE �1 NO.&LENGTH OF UE NE. .J -S '"'>` /T+ DISTANCE TO NEAREST:WELL l ' � FOUNDATION y'C" PROPERTY LINE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE - MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE PITS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SUMPS -IMDTH -'Z LENGTH lC'� DEPTH DISTANCE TO NEAREST:WELL ' FOUNDATION �7 G'' PROPERTY LINE/(-'V' '�- DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT 1 HAVEPREP D 9 APPLICATION ND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES -Rc- AND REGULATIONS OF THE BAN JOAOUIN COV .HOME O OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERM ISI UED, ALL NO EMPLOY PERSON I 9 CH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB-Co CTI NATIf1�CE IFIES THE -LOWING: 1 C 'FY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1$HALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COM N AT''C1`L•I F CALIFO�- TAIIUST CALL 24 HOURS IN ADVANCE FOR ALL REG`IIRED INSPECTIONS. COMPLETE DRAWING BELOW.SIGNED ITITLE: DATE: PLOT PLAN(DRAW TO SCALE)SCALE -to 1. NAMES OF STREETS OR ROAD NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY, DIM ONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. ..... ... :.. .... :......i.... _. .. .. .. :.......-. ...... . . ......:............. .. .. .. .. .:.....:.....:. i :......E.....• ......i......• .......:... ;.. ..:.. Af.:......:......r.-....;.......:......:...... ......?.......:..............:.._......_...........t.... .. ......... . ..�....! ......E......,.... .. .. ....... . ,. ' ..... ..............:................ . iULSA i - _ ...7 LS L11L 'J :. . .....: .... ...... t r.... .....€....... .. . -_.:..............:..............:.............. ... ac#e.a. �I�� ......<.. fi. ................... +r..i ...... ...... ... .: ,.. . .:.......:....... .. .. .................:............................................ .. . . . : .. . ... ......................_.................................................................€... .. ...... ' . : Um 2.199.