Laserfiche WebLink
APPLICATION FOR LIOUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH . -RVICES <br /> Q0 i ENVIRONMENTAL HEALTH DIVISION <br /> l 304 EAST WEBER AVENUE, STOCKTON, CA 95202 '(��j 1 <br /> (209) 468-3420 <br /> r MON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUER <br /> ICBInPbt6 in Trpliest6l APPLICATION <br /> JOAUAPPLICAN IION O 09 H REBY TO THE <br /> TREE. N JJOAQUIN C 70.3 MR A KHMIITpI TOC a OFT JOAQUIN IC UNTY NBLNSTALL THE WIC HEA TH 6RK B NCE6.IEN RONMEMAL EALTH DIVISION^NCE WITH SAN <br /> J Sr�e-S CITY LOTSIZE�RSF <br /> E 67 <br /> JOB ADDRE68IOR APNI ! <.1 � �{V PHONE �� �/2 <br /> F/�{.L,(�y� <br /> ADDRESS l/C YX�F- <br /> OWNER'SNAMF 'J //� <br /> V[- PHONE--- <br /> ADDRESS 'J u F / ?? MONE �� <br /> CONTRACTOR y/' <br /> SUBCONTRACTOR- 1 `' �" �E= ADORES �� <br /> gEPNWAODITION ❑ DESTRUCTION ❑ <br /> TYPE OF SEPTIC WORN: NEW INATA"TO PgIC 1"71.1 l 1 NOW MANY <br /> INO SEPTIC SYSTEM pERMITTED IF PUBLIC SEWER I AVAILABLE WITHIN 200 FEET Of BUIIWNG.I AIP6sNen f <br /> INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL❑ OTHER ❑ ' <br /> NUMBER OF SEDROOMS: NUMBER Of EMPLOYEES: zO <br /> NUMBER OF)MNG UMTS:_ - ^TER T^BLE.COM <br /> /FN PRISVMP SOIL CNARACTER: <br /> CH�M[�\CTER OF 601E TO A DEPTH OF J FEET: f � e� CAPACITY I� Rl NO.COMPARTMFNi6 <br /> CE <br /> TANE/OREA6f TRA) ❑TYPEARfO PROPERTY UNE IAS-` <br /> IAKG-1(1/ 1 FOUNDATION Ir <br /> EATMENT PLANT❑ DISTANCE TO NEAREST: W U- ell ) J <br /> TYPE Of PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM)�� R l`/h <br /> SIFT STATION❑ SIZE �" d FOUNDATION /� PROPERTY LINE 7 <br /> LEACHING UNE O.S LENGTH OF LINES �"�f=DISTANCE TO NEAREST'WELL �� <br /> WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL <br /> FOUNDATION PROPERTY UNE \� <br /> FILTER SED FOUNDATION PROPERTY UNE <br /> ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL�T �-�I <br /> MOUNDED �'�iOUNDATION�PROPERTY UNE <br /> Vey_=�H lC LEZE '1,JCCi Rt NUMBfP �� DISTANCE TO NEAREST:WELL ppppERTY UNE 1 <br /> SEEIAGE PITS CJ0.YL ��L FOUNOATN)N <br /> ❑WIDTH IENGTN DEPTH DISTANCE TO NEAREST:WELL pROPERTY UNE C <br /> SUMPS POUNDATgN <br /> DISPOSAL POND6 ❑WIDTH <br /> LE DTH DEPTH DISTANCE TO NEAREST:WELL <br /> IHERE CERTIFY THATIHAVE PREWINCOUNTV. OME OWNEROR LICENSED OA SILT'S SIONAOURE CERTIf ETB HE FOLLOWING:JICEIITIFYTHAT CONTRACTOR 8 <br /> pHRING On '\ <br /> AND G TIONS OF E <br /> THIS PEPM I81 RTIF EH THE F L YVINO:MI CERTIFYITHAT IN THE PERFORMANCE OF THE WOR(FOR WNICN NRSPERM 8 BSUED.I WALL EM0.0V PERSONS SUBJECT TO f, <br /> V e F CALIPO PPUC^ T MUS CALL]�HOURS IN ADVANCE FOR ALL RFGURED INSfNiCTONs. COM0.ETE pgAWING BELOW. <br /> BUB CE CTI G81 I E <br /> WOR(MAN'S <br /> L TL J I 1 T <br /> TrtLE: DATE: / ✓ -/ / <br /> SIGH X <br /> ROT PUN IDMW TO SCAT)BC^lE— <br /> 0 <br /> t. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 1. NAMES OF STREETS OR ADS NEAREST TO OR BOUNDING THE PROPERTY EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> Z. OUTLINE OF THE FROM WI <br /> TH DIMENSIONS AND NORTH DIRECTION. 6. LOCATION OF WELLS THIN RADIOS OF ONE HUNDRED FIFTY FT.ON <br /> J. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, THE pROPERTy OR ADJOINING PROPERTY. <br /> INCLUDING COVERS AREAS SUCH AS PATIOS,DRIVEWAYS.AND WAIXS. - <br /> � 10 <br /> rFo� <br /> -----.—,1[F ONLY ., l <br />