SU0002230 SSNL - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 > (209)468-3420 RNON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED 'ly (CBmplatE in Triplicate) APPLICATION 18 HEREBY MADE TO THE AN JOAQUIN COUNTY FOR A PERMR TO CONSTRUCT AHOMM INSTALL TIRE WORK DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH BAN JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. A JOB ADDRE66/ORR A71`�NIf) ��,�I 17—�H / w✓1 S CITY `—�� SLOT SIItZEAC,- � OWNER'S NAME I/X� �"�«��' ADDRESS Z,41,--LL PHONE /"//f CONTRACTOR ADDRESS / LIC/ PHONE SUBCONTRACTOR_ /"/� t ADDPFS.(ZI `• c-`1'L^��• TYPE OF SEPTIC WORK: NEW INSTALLATION❑ REP.AIRIADDITIONTO DEATRUCTL.N❑ IND SEPTIC SYSTEM PERMITTED If AIBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PEAC T-THI I I HOW MANY INSTALLATION WILL SERVE: RESIDENCE r COMMERCIAL❑ OTHER❑ NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: CP7TAR OF SOIL TO AD PT HOF J FEET: FF' P1T16UMP 601E CHARACTER: WATER TABLE DEPTH l C TA K/OILEASE TRAP 01.1-0111,X �e�* CAPACITY I C,-C� NO.COMPARTMENTS VI, UTMENT PUNT❑ DISTANCE TO NEAREST: WELL O FOUNDATION S ( PROPERTY LINE(�U UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM) ��,�pppp{{{{IIII ��// _ / LEAcRNG ONE NO.a LENGTH OF LI `-1NE6 C), DISTANCE TO NEAREST:WELL FOUNDATION / PROPERTY LINE FILTER SED WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION P PERTY LINE MOUNDED ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE SEEPAGE ATS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINET BUMPS ?93),MDTH Z C LENGTH_DEPTH H' / DISTANCE TO NEAREST:WELL 1 490 1 FOUNDATION 21-7' PROPERTY LINE) CI 0 DISPOSAL PONOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE I HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE BAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 IBBVED,I BH LL IJOT EMPLOY ANY PERSON M MUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS Of CALIFORNIA.- CONTRACTOR'S HIRING OR eV0{ONT T MNINA -MLFIEe TME F LLOWINU:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOA WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO AN'B MPE T U 8 OF CALIM IA.' THE APPIJN MUST 111 224 HOURS IN ADVANCE FOR ALL REGURED INSPECTIONS. COMPLETE DRAWING BELOW. S -� PLOT PUN(DRAW TO SCALE)SCALE_ 1.NAMES OF TREETS OR \DS�lEAREST TO OR BOUNDING THE PROPERTY. Ie4. LOCATION OF HOUSE SEWAGE DISPOSAL BY STEM OR PROPOSED 2.OUTU HE OF THE PROPERTY, H DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYMMS. 0. DIMENSIONED OUTLINER AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, G. LOCATION OF WELLS WITHIN RADW8 OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. u(' 99-15 .. . fvSPEG 1 EU BUT NOT SIGNED OOu., �s pa4YNfEPf7 ..... a7 AUFIDI IC TH TH$FENCES 1' P =7JVIf90NMENTAL HEALDIVISION _ 54 �11/,/ ax/ax/c) F D APTMERT USE ONLY S�j APPLICATION ACCEPTED By DATE'. jf / AREA: TANK,PIT OR SUMP INSPECTION BY DATE / / FINAL INSPECTION BV DATE ADDITIONAL COMMENTS: ACCOUNTNG ONLY: AIDI FAC/ PE COO, FEE INFO AMOUNT REMIITEO CHECK/IC ASH RIC—81 GATE SAI PERMIT NUMBER INVOICE I 1 10(( YL Pub.Health Saw.-Erwim.174(3/96)