SU0012526 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUSUC HEALTH SERVICES Ll ENVIRONMENTAL HEALTH DIVISION {{{ r 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468-3420 MR-RITUNDABLE PERM(T EXPIRES I YEAR Mg DATE ISSUEP lCa"IPSS In TdpAnlo) APPLICATION hT HOWNY MADE TO THE SAN JOAOU/N COUNTY POR A PERMIT TO CONSTRUCT ANDOR INSTALL THE WORK DESCRIED.THR APPLICATION R MADE N COMPLU/1C'f WITH 4N JOAOUIN COUNTY oFmjomKmT�TITLLE�CHAPTER 9-1110.3 APO THE STANDARDS OF OAN JOAONN COIMTY rU@M ISiKTN SERWCEE.EWNRONWNTAL HEALTH D/VWON. JOS ADDREBBNR AMP /-'T/7 S /L'�i iY/Y Com' JQ f! CITY LOT UZI OYMEA'S NAL EZ'/ LLL=a(—A CAF5, C7• '13�Lil �/�Z 1{7.L1 ^1DI�=i J CONTRACTOR ��:---�` /LLC=/L AoonEEE ��U• ' !'/j .L.Or�'t�P uc nlo•NE s.s� `�f�/ $US CONTRACTOR ADDRESS LIC/ [110Nf TYPE OF■BDG WORE: NEW INSTALLATION❑ REPAIDADURTION DMTNXTICN❑ ONO SEPTA:SVETEU PEIMRTED IF PUSUC SEWER IB AVAILABLE WITHIN 300 FEET OF BNLDIN0.1 PEW TWO)I I MOW MANY .�,,II . AFP$aPhn. INRAILATION WNL STRVl: RESIDENCE❑ COMMERCIAL pL OTHER❑ 9402 wk*Mm NM LMNO METS: mmam OP B[DROOMS: RLELYm OF MPLOY®: CHMACTER OF SOIL TO A DEPTH OF]FEET`SfE'L'I`EIIP�i(�16UMP BOIL CMRACTPR: WATER TAKE DEPTH _ $EPHC TANC10IM&SE TMP ❑TYPFAE0.7 CAPACrrY NO.COMPARrAENT PSO TREATMENT PLANT❑ DISTANCE TO REAIEA T: WELL FOUNDATION PIIOFFRTY LE UFT STATION❑ KIM TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYETEMI _ LEACMNO UNE L7 NO.a LENGTH OF DIRE MES STANCE TO NEAREST:WELLFOLMDATION�.PIIDPQRY UNE �� FILTER SED WCTH_!!�/_LU40TH� DEPTHIA- DISTANCE TO NEATER:WRi,E _FOMCATpN FMMURTY UNE MOUNDED ❑YOOTH LENGTH DEPTH DISTANCE TO NEJUEST:WETl FOUNDATION PROPERTY LINK SEEPAGE PIT$ ❑DEPTH SIIE NMISEn DISTANCE TO NEAREST:WELLYOUNDATIOH PROPOLTY LNE RRSPS ❑WDrH LENErH _DEPTH DISTANCE TO NEAREST:WILL FOUDAT WN PROPERTY LNE DISPOSAL POND$ ❑VADTH LENGTH DEPTH OISTANCE TO NEAESTl WELL FOUNDATION PROPERTY LEE I HEREBY CERTIFY THAT N HAve PREPARED TMS APPMATION AND THAT THE WORK IMLL K DONE N ACCORDANCE VATH AM JDAOUIN COUNTY ORDINAHM AND STATE LAWS.AND FINES AND FWMA LTIONS OF THE SAN JOAOMNCOUNTY,HOME OVWERORLICMIKI)A0EHT-9 8I0"ATI/1EClOT"F1ES THEWUO'AEIO:'ICOOEVTHAT IN THE PEI►OISAANCE OF THEWORK PORWINCH THIS PERMIT IS ISSUED.1 SHALL NOT EMPIOY ANY FEISON M SIKH A MANNIM AS TO 91FCOAE FMECT TO WRNKMA7S COLPPEHEATON LAW$OF CAL/OMML' CONTRACTOW S MAIN OR SU6COWTRACTINO SOHATURE CEWrVKB THE FOLLOYAD:1 CERTIFY THAT EJM 'HAT'IN rHR FERPORWANCE OF THE WOK FOA V"CH TMS PIT R 190M.19S .I NNA L E1/LOY PERSONS SUS.IECT TO WORK AM,@ COAs/BNSIAANION LAVA OF CAFORMUL' THE APPLICANT MUST CALL 24 HOW IN ADVANCE Pool AM R0011A UD MMUCMRS. COSILETE MAMANO SELOW- J,'yxy PIONED% //'- i_✓[�•C�L/ TIRE: DATE: ✓ ROT PLAIT DRAW TO SCALED OCALE 'to 1.HALES OF GTIIQTS OR MAD$NFAMOT TO OR BOUNDING THE PROPERTY. 4.LOCATION OF NOUBE SEWAGE DISPOSAL SYSTEM OR PROPOSED i. OUrLNDNE E OF THE PROPERTY,WITH DNSIONS AM NORTH DIRECTION. EXPANSION OF SEWAGE D OMAL SVSTWAS. J. D A DMONED OUMNES AND LOCATION OF ALL FXISTIHO AND PROPOSED STRUCTURES. S.LOCATION OF WELLS YRTMN MADAN OF ONE HUNDRED FIFTY FT.ON INCUIO/IG COVETED MESE KOCH M PATIOS,DRIVEWAYS.AND WAILS. THF ROFERTY OR AD.JONRNO P OPERrY. TAs� `. `�o.. ° . . ... . D. lt1Pr Ivlr'� L . R, /�� ; N e�- :......:. . .............. ... .. :. —Ns 04 r a 1. r ........... .. NOV . .. .. eel • ,�' .�':�.Vim•'T '+4;....t.h, ....-..71.i' . .............. .. ..... ............... .: ....... ... ,V`TV 1 u �MR DEPARTMENT E ONLY APPLICATION ACCEPTED BY I" /�✓`��/\� _DATE: /O L v � (� /WJ1: �2r � TANK.PIT OR SUMIN P STL DATE K N N / / FWSHLTION SV bATN�`� AourMNK COR.NAENTB: PET ."OLY: AD# FAC• coa. AMOUNT RE.STTED CISECIIS ASH PCtEVED$Y DATE P 6 LIZ? Pub.HSS1ttI SON.-Errnro,174(3xM)