SU0004712 SSCRPT - Laserfiche WebLink

Home Browse Search

1PPLICATION FOR LIQUID WASTE PERMIT / S,c„ JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.D. BOX 388, 445 N. SAN JOAQUIN ST., STOCKTON, CA 95201.0388 (209) 468.3420 q f� NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED vZ( '"/ " _��, (Complete in Triplicate) 4PPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITTLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,,ENVIRONMENTAL HEALTH DIVISION. A,, JOB ADDRESS/OR�APPNX Z�/��__,p�Z/�f��W W J �_D, l.�l.` / I ` (CITY �t\& y ��(�" �/L�-k�O�T�SIIEE/3V(R&-'. )WNER'S NAME_ 1� -T Nk.�pt�-,C,I�VT�K-i`J�fy�l�5 ADDRESS �A p�, ^ PHONE . 2�L-2-4109-7 10'9 CONTRACTOR•""'��y�� J UVtV� Tt-41✓.ADDRESS �S0 �� t (3V,/rJ 'R-D, LICx75959 8 PHONEJ69'Z-'56Z-- >UB CONTRACTOR ADDRESS LICK PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION 19 REPAIR)ADDITION ❑ DESTRUCTION ❑ (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTI):)I I HOW MANY Application f .NSTALLATION WILL SERVE: RESIDENCE W COMMERCIAL ❑ OTHER ❑ .yam NUMBER OF LIVING UNITS:) 05 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: . :HARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISSUMP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANKIGREASE TRAP ®TYPE/MFG LJ.,1 I r�L- CAPACITY I,f000fIQ.t'6 1J 0.COMPARTMENTS PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL 16000) FOUNDATION �J 1 PROPERTY LINE S UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) .EACHING LINE NO.h LENGTH OF LINES 410 K DISTANCE TO NEAREST:WELL 4VC�O Z�FOUNDATION AC) / PROPERTY LINE_ FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH 2-"51 � C LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE �f >EEPAGE PITS R DEPTH 2--J 1 SIZE a(0 I NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE /S ;UMNPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES kND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:"I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO NORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR /ALL LRREQUIRED INSPPEEC�TIO-N&.. COMPLETE DRAWING BELOW. SIGNED X TITLE: 1.J17 TSI fc�ly �� DATE: PLOT PLAN(DRAW TO SCALE)SCALE 'to I. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED -2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS 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. _. '. __ .... ._. .. ... .................... ... .. ...... .—J tf� . . .. .. ...................... ;boo .. .. ..:.. ...;.. ..... ...;....:.. ...;. . :... :.. Z' 7 1...1 __. .. .. - .. .. .. .. .. .. .. .. I ... .... ...:. ..:. .:..... ...... ...:. .............. .... ............................... " .................. . .. .. .. 5' 4 1 7, o RECEIVEL .. ... ............ -K^ ►�'Q, iszvs,l�c,� P �Q ... ........... .... .