SU0002650 - Laserfiche WebLink

Home Browse Search

1PPLICATION FOR LIQUID WASTE PERMIT SAN-JOENVIRONMEQUIN N ALN AL HPUBLIC E DIVISIONALTH ✓ICES F L E COPY (') 304 EAST WEBER AVENUE, STOCKTON, CA 95202 ��j (209) 468-3420 - _ NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete In TripReete) APMICATION IR HFnERY MADE TO THE RAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. T141S ArMICATION 18 MADE IN COMPLIANCE WT14 RAN JOAOUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OFI SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICER,ENVIRONMENTAL HEALTH DIVISION, JOB ADOnF89/On APN# —;IL'{5,��^.' ^,V" Y_I�FL�1C! CITYLOT 617F QZ,ps OWNFE'R NAME _AOORFSS `ggPW"\C- PHONE �p� -�� 1 CONTRACTOR Cp-}� _ ��1 �[_ ADDRESS p5�1 �J('�;_�(�-1"—L�•+ �f� UCI :$�+.7� PHONE �i p- (�7.33 FUR CONTRACTOR ADDRESS LIC# PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION Pf DFATRUCTION ❑ IND SEPTIC RYBiEM PERMITTED IF M1BUC SEINER 16 AVAILABLE WITHIN 200 FEET OF SUILDING.1 PFRC TEST(.)1 1 HOW MANY APPee�tlen / INSTALLATION Will SERVE: nFSIDFNCF 19 COMMEnCIAL ❑ OTHER ❑ NUMRrR OF LIVING UNITS:_I NUMBER OFF BMAOOM6-� NUMBER OF FMPLOYFF8: CHARACTER OF ROIL TO A DEPTH OF 3 FEET: L=I 1'I PIT/RUMP FOIL CHARACTER:ni't"I 75PMW - WATER TABLE DEPTH IOa 1 SEPTIC TANK/GRFASE TRAP ❑TYPE/MFG CAPACITY NO.COMPARTMENTS EKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WEIR FOUNDATION PROPERTY LINE LIFT 8TAT10N❑ RUE TYPE OF PIMP RAND OIL SEPARATOR IENCLOSED SYSTEM) LEACNNO UNE `LL NO.•LENGTH OF LINER / ,h -110 DISTANCE TO NEATIFST:WELL�OG', FOUNDATIONS,_PROPERTY UNE /OC7 7 FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTN DEPTH DISTANCE TO NEAREST:WEI.L FOUNDATION PROPERTY UNF REFPAOE PIi6 ®DEPTH -� SIZE 3L-, " NRIMRFn__)_DISTANCE TO NEAREST:WEIR_FOUNDATION_3,-' PnOPERTY)INF /Vv' SUMP6 ❑WIDTH LENGTH DEPTH DISTANCE 70 NEAREST:WELL FOUNDAMN PROPERTY LINE DISPOSAL POND@ ❑WIDTH LENGTH) DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I NFnEBY CERTIFY THAT 1 HAVE PREPARED THIS APMICATION AND THAT THE WORK Wil L RE DONE IN ACCORDANCE WITH RAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND mR FR AND REGULATIONS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'B SIGNATURE CERTIFIES THE FOU OWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK rOn WRAC)) THIS PERMIT I818RUED,I SMALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WOPIKMAN'8 COMPENRATION LAWS OF CALIFORNIA.' CONT RAC TO R'8 HIRING On SUR CONTRACTING SIGNATURE CERTIFIE8 THE FOLLOWING:'I CERTIFY THAT IN THE PEETORMANCE OF TNF WmIK FOR WHICH THIS PERMIT IS ISSUED.1 SMALL EMMOY PEn80N8 SUBJECT TO W WMAN'R COMPENBAi LAWS OF CAUFO IA.' THE APPUCANNTT^MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INBPECTION4. COMPLETE DRAWING BELOW. �.j SIGNED X C j-'-- I<— TITLE: CA-Z)✓I�� DATE: -9 J - 9 / PLOT PLAN IORAW TO SCALE)SCALE__'to 1. 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 D18POSAL SYSTEMA. 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 WALLS. THE PROPERTY OR ADJOINING PROPERTY. 011 :. . _._.. APR G 1999 SAX JC)�Wt11N C1-?UNI � 6 t, ^.,F,'V4UC.H ATH SEHVI� .,. CNVIRI:`NMENFAl.0EAI.1m plW IR FOR DFPAPTMFNT USE ONLY APMICATION ACCEPTED BY DATE: / ' t,J — ( AREA: _ TANK,PT On SUMP INSPECTIOH BY DATE / / FINAL INSPECTION BY DATE ADDITIONAL COMMENTS: ACCOUNTING ONLY. AIDS )) FACT PE CODE FEE INTO AMOUNT RUM TED C11EC1,"k ASM RECEIVED BY DATE 6R/PERMIT NUM8FB INVOICE Ili 1'60 L5 A, Puh.Health Serv.-EnViro.174(3/96)