Laserfiche WebLink
APPLICATION FOR LIIIUIO WASTE PERMIT <br /> SAN JOAQU(N COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> I DPS 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOR-IIEfUNDABIE PERMIT EXPIRES I YEAR F OM DATE ISSUED <br /> KompNta In TrIPRFuta) <br /> APPLICATION 19 WFICRY MADE TO THE GAN JOAO—COUNTY FOR A PEPMrr TD CONSTRUCT ANOA7R NSTAJi THE NUAK DESCAMEO. TML AP"JOAMN IF MADE N COWMANCF WITH LAN <br /> JOAOUN COUNTY DEVEIOPPMEENTTTITLE•CHAPTFF%9.11}0/.J3/AM THE[TANDARDS OF @AANNN JOAAOLRN CCUMY PURLK:HEALTH RIRVICEL,ENVHD/M'./E/LATE HEALTH Ud"G1 N. <br /> Cm �LT+)�r JlzPZJ�+ /) y��/ <br /> OWNERS NAME / (�2/lJl.a..( ADDRESS <br /> CONTAACTOgz'-,,tu.i - Zf�.cu ;Fri yes X277 -'Z---- ucA 39�fCj PHONE <br /> sum COINTM OA ��� ADOPESS LIC/ "HONE <br /> TYPE OF SEPTIC WORK: HEW M-ALLAnON❑ R[PMWADM— DEaTR T.N Cl <br /> LPD SEPTIC RVYTEM FERMITTED IF FVBUC SEWER 16 AVAAABLE WITHIN 200 FEET Of BUILDINOI PO1C TLti wl 1)MW MAXI <br /> Ty� <br /> APPaeAbw/ <br /> NSTALLAT—Wa..l SERYE�DENC COMMENCLLL LIOTHER El J L� <br /> RIMaRR OF UNRG Los- NUAl9R OF LFDROO MJt: mul-w K RAPLOYLG <br /> CHNFACTER OF SOIL TO A DEPTH Of S FEET:_ f' fEUMP 50[.CNARACTFA: G 1 r� WA7EA TALLE <br /> SEITM TANK/ONAEF TRAP ❑TYPUNa'a CAPACITY NO.COMPARTIAEMY <br /> PKO TREATMENT PUNT ElLI <br /> M.TANCE TO N[AALTT: WELL FOVNDAT.N PROPERTY NE / <br /> U►T ITAM" <br /> ❑�Rf2E TYPE OF PUMP �+.l SAND OIL LEPAIUTOR rE 1 LOBED SYaTEMI <br /> LEACHING UNE ia�+-NO,a LENGTH OF .. /-yy "STANCE TO t AM—WELtf.LS L�i FOVHO'�TIOH PROPERTY UNE ZOO � <br /> FILTER aM ❑WIOTH LEHOTH_ DEPTH "STANCE TO NEAREST:WELL FOUP:OAMN PROPERTY UNE <br /> MOUNDED []%MOTH LENGTHDEPTH "STANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> tQ►AO[ITra DEPTH SIZE_ c�/J NUMBER_�DMTANCE TO WAAEST:WELlj,,O�FOUNDATpN�PROP[PSTY L. <br /> SWPS ❑Ww)TH LENGTH _DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTYUNE -5 <br /> "SPOM PONOa ❑WaJTH LENOTH -DEPTH "STANCE TO NEAREST:WELL__FOUNOAMN PROPERrY UNE <br /> 1 HERESY ClRnFY THAT 1 HAVE PFEPARM THIS APPLICATION AND THAT THE WORK W W DONE IN ACCORDANCE WITH GAN JOAOUIN COUNTY OMNAACES AND STAT!LAWS,AND PULES <br /> AND REOULkM"A OF TIE VAN JOAOUIN COUNTY.HOME OWFAR OR UCEVeEO AGENTS SIGNATURE CEEB R[•THE FOU17YONG:I CENTS THAT LATHE PEP[CAWANCE OF IHE WORK Fo1RVAOCH - <br /> THIS PEMYT la RaUIED,I LNALL NOT EMPLOY ANY PERSON N SUCH A MANWR AS TO BECOME WUSJECT TO W ORKMAM'L COMPFN*ATTON L&WO Of CAUF""A.- CONTAACTOFFR HWVM OR F1 <br /> tU&CONTPAL ME ATURE CERT1FWa THE FOLLOWNO;'N CTJTPY THAT M THE FlTIFOMANCE Of THE WORK F04 Wi[CH TMS PURST la ISSUED.1 TNAIL F&WLOY PERSONS SUBJECT TO ` <br /> WORKMAN'a COM T10N LA <br /> OF CALIORIA."THS APPLICANT MUST CALL N ROMA W ADVANCL FOR ALI.,RE�Ojl RAM INSPELILONt.COMPLETE DRAMANO BELOW, <br /> ROVED K l TrtLE:^c✓l�'_/ DATE: <br /> PLOT PLAN MFIAW TO SCALA SCALE ro <br /> 1.NAMES OF 9TPWN OR ROADS NEAREST TO OR SOUNDING THE PnOPL71TY. A. LOCATION OF HOUSE SEV/AOE DISPOSAL O MFAI OR TTgPO1ND <br /> 7.OUTUNE OF WE PROPERTY,WITH DOAENSIONS AND NORTH DWICTION. EXPAAI ION OF LEWAOE OISPOM SYSTEMS- <br /> DIMENSIONED 3. DIMENSIONED OUES AND LOCATION OF ALL E.TISTNO AND PROPOSED SIRUCTUREC, s.LOCATION OF WELLS WITHIN RADR)I Of ONE FNNDRED"Fry FT.ON <br /> NCLUDINO COVEAED AM"SUCH AS PATIOS,DRVEWAYS,AND WALKS. THE TROPUrTY OR ADJOMING PHOVIVI-Y. <br /> :....:.. . ` r. ......... .�._.. . . <br /> ........... . <br /> T � - <br /> 4 PAY <br /> u <br /> dI : <br /> :... . <br /> ... ..... . . <br /> - •: $VVI <br /> ' • � �: AL F;lEALth R71V191U1+• <br /> FOR DEP PTNIENT USE ONLY <br /> APPLICATION ACCEPTED BY �_� DATS! <br /> T RT M1PN®ECTgItDATE b,/SOV FI NALINSPECTK)"my OAT! / <br /> ADDgNA1 GO EPOI <br /> R 6 <br /> FCCOUNn F.00NLY: AJUA FRCP MITI <br /> R'CODE fFE lAFO AAIOL'N/RYAI IIID )ITT' !CASH RECEVM BY OA-M YI I FRAST NL W INV"CE I <br /> 15-77/ <br /> 5 A 5`x'1 <br /> Put.Health Sery-ErkOrO,174(3196) <br />