Laserfiche WebLink
r 6�7_ 'RN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> " ENVIRONMENTAL HEALTH DIVISION l./ <br /> P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 95201.988 <br /> j (209) 438.3420 ?"f>0 s- q <br /> y�V NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (Complete In Triplicate) <br /> APFLICATION IB HEREBY MADE L THE SAN"AWN COUNTY FOR A PERMR TO CONSTRUCT ANOAR INSTALL THE WORK DESCRIBED. THIS APPLICATION IB MADE IN COMPLIANCE WRH BAN <br /> "AMIN COUNTY DEVELOPIAPM TIRE.cmAPT0 R-1110.3 A THE BTANGAPOB DF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. S <br /> JOB ADDPEBSAR APNI 1 CITU � LOT SC G�L <br /> OWNER'S NAME ADDRESS--2—"3 S RHONE /fin J <br /> CONTRACTOR ADORES6 ) [��7 �1/TgMi 1T�� LN%I � �y RHONE �� / ��/( <br /> SUB CONTRACTOR ADDRESS LK/ RHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPMRGDDIT10N ❑ DUTINCTION ❑ <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAIHARLE WITHIN 200 FEET OF BUILDING.) PFRC TESTI.)1 1 HOW MANY <br /> �.// Appllaetlon! <br /> INSTALLATION WILL SERVE: RESIDENCE[J COMMERCIAL❑ OTHER 11 <br /> NUMBER OF LIVING UNITS:/ NUMSER OF BED OMS: _ NUMBER OF ENIPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OFFrpe3.�FEET- / PSR}/BUMP SOIL CHARACTER: JJ �y^ WATER TABLE DEPTH ��,� y <br /> SEPTIC TANVOREASE TMP CJTYPEIMPO (IY'TC?T/LL,Gi� CAPACITY la2C�0 NO.COMPARTMENTS f <br /> PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> LIFT STATION❑ Sin TYPE OF PUMP BAND OIL SEPARATOR(ENCLOSED SYBTEMI <br /> Cy ' <br /> LEACHING LINE NO.6 LENGTH OF LINESi 'CIA DISTANCE i0 NEAREST:WELL FOUNDATION PROPERTY UNE <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL. FOUNDATION FBOPERTY LINE <br /> MOUNDED 111/WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL E <br /> FOUNDATION PROPERTY UN <br /> SEEPAGE RTS L7OEPTH2�SIZE jV' NUMBER_DIBTANCETONEAREST:WE1.200 FOUNDATION G0 MOPERTY LINE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK HALL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE SAN"AMIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-ICERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br /> THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUFOMIA.- CONTRACTOR'S HIRING OR <br /> SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> SWOIKDM%N^8 COMPENSATION WS OF CALIFORNIA.' RI UBT CALL ZS HOW.IN ADVANCE FOR ALL RE TIONS. COMRfiE OIIAWINO BELOW. , <br /> -�V -!Y TRIS: GATE: <br /> VPLOT PLAN[DRAW TO SCALE)SCALE -IP <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. S. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTUNE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, E. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AB PATIOS.DRIVEWAYS,AND WALK$. THE PROPERTY OR ADJOINING PROPERTY. <br /> a � <br /> Q G <br /> I <br /> YML, (� <br /> SEP, 151 8 <br /> XKVof )r <br /> a PUBLII,HEALTH$ V <br /> F ``tel NVIFfONMENTAI,HEAL H IVJSIC,.. <br /> 3o cI T �•' (� � 'P�� <br /> r.- 0 �, .{^L.E/_/FOR DEPARTMENT USE ONLY -//T <br /> APPLICATIONACCEMEDRY `T I/"�J-.Y/1 �•�✓'l�{/ r(/1` DATE l I �fl�l 1.� l ance. ? <br />