SU0013003 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. 13OX 988,3" EASE'WEBER-AVENVE, STOCKTON. CA 95201388 (209) 461.3420 NON•REFUNVBLE PERMIT EXPIRES I YEAR FROM DATE ISSUED 1CBBIp11tB Is TrIpRuts) APPIICAT"IR WAEDY MADE TO THE DAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AHCtCR INSTALL THE WORK DESCRIBED. THIS APPLICATION It MADE W COMPUAWE NATV,PAN JOAQUIN COUIRY DEVELOPMENT TrTLE7.CHAPTER 9.1/1110.3 AND THE STANDARDS OF BAN JOAOVIN COUNTY PUBUC HEALTH4 SERVI�CE4WULRDF*mNT/LL HEALTH DIVISION. JOB ADOREBSUOR.APNf C/ � 1–U• J' _V/ '!"�J z�t� Lot elle V=a CrrY1 OWNER'e NAMfIsC'�L„JN Sr:1 hIC •�,s L. ADORCSB +7 £. • kJFy<�'[ PHONE - CONTRACTOR V ADOIEee UC/ PHONE BUB CONTRACTOR ADOREOS UC/ PHONF. TYPE OF SVTIC WORK: NEW WSTALLATION^93: REPAJIIlADDITION ❑ DESTRUCTION PNO SEPTIC.SY97EM FfMM1I TED IF PUBUC SEWER 19 AVAILABLE VAT MIN 200 FEET OF BUIL.OHNO.1 POW TUThI I I HOW MANY APdlo.den INSFALLATION WILSERVE: AT9IOFM:EA COANMERCIAL OTHER 11NUMBER W LMNO UNITS: I NUNIZEN OF SEDROOMS' f-- NUMBER OF EMPLOYEES: I() CHARACTER OF BOIL TO A DEPTH OF S FEET1 FMr/OUMP SOV.CHARACTER: �1 WATER TABU DEPTH SEPTIC TANKIOREASE TRAP ❑TYPEWFO �Ct- L— CAPACITY I !(0 On NO.COMPARTMENTFi FICO TREATMENT PLANT❑ DISTANCE TO NEAREST! WELL toot T FOUNDATION PROPERTYUNE LIFT STATION❑ R97E TYPE OF PUMP BARO OIL SEPARATOR IENCLOSED SYSTEMI LEACHING UNE NO.S LENGTH Of UNE/ f (�Z) /w YZq D 1 DISTANCE TO NEAREST:VALL FOIMDATIOV PROPERTY LINE PILTIM BED ❑WIDTH LENGTH OEPTH DISTANCE TO NEAREST:WELL FOUNDATION FROPERtY UNE MOUNDED ❑WIDTH LFNOTH_ DEPTH DISTANCE TO NEAREST:WHI FOUNDATION PRO PERTv UNE O SEEPAGE Ply■ ❑DEPTH-SIZE-- IZE — NUMRFR DISTANCE TO NEAREST:WELLFOUWJATKIN PROPS FTY LINE sum" 11 WI sum" LIENO7H —DEPI H DISTANCE TO NEAREST:WELL F01A#DATION PROPERTY UNE ('S OIS►OSAL PONOS ❑WIDTH LEYNOTH DEPTH 019TANCE TO NEAAFST:WFLL FOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT t HAVE PREPARED THIS APKXATION AND THAT THE WOFK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AHD STATE LAWO.AND RULES AND REGULATIONS OF THE BAN JOAQUIN COUNTY.NOME OWNER ORLICFNVED AGENT'S SIONATURE CERTFIEB THE FOLLOWING:11 CERTIFY THAT IN THE PErfOP/AANCE OP THE WOFIC FOR WIMCM THIS PEPIMIT 19 IBOUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WOWMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOA'B HmM OR SVS-CONTRACTINO MONATVIE CERTIFIES THE FOLLOWMICT:7 CERTIFY TH.*T IN THE PERFORMANCE OF THE WORK FOR WFPCH THIS FERAVT IS ISSUED.I SHALL EMPLOY PERSONS SIAWCT TO WOWCMAN'S CO TION LAWS RNUI' THE APPLICANT MUST CALL 74 HOURS IN ADVANCE FOR ALL RE(VAIE�DfR,tpWWMNS. COMKM ORAWRM BELOW. SIGNEO x Y TETLL;��^•��7►v C Y� DATE:_S _" 9 T PLAN(DRAW TO SCALEI SCALE to 1. NAME&OF STREETS OR ROADS NEAREST To OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE BEWAOE DISPOSAL SYSTEM OR PROPOSED 2. OUTUHE OF TIE PROPERTY.WITH DIMENSIONS AND NORTH OSECMN. Eh PAHMN OF SEWAGE DIWOBAL SYSTEMS. 0. DIMENSIONED OUTLINES AND LOCATION OF ALL IRISTINO AND PROPOSED STRUCTURES. S. LOCATION OF WELLS MRTHIH RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDBM COVING AREA@ BIRCH AS PATIOS,ONWWAYS,AND WALKS. TNF PROPERTY CIA ADMIN"F7OPER1Y. I . i i � 1 r• V, ti�o�1 JQc 0A o' 7 IL YM Nil- -cry IF of- pa. "MAY 1. 51991 SAN JVAU.IIL,LUL% / — -- PUBLIC HEALTH gFR�(Irs=c F011 ObAfETMBIT USE ONLY AF'PL.ICAIION ACCEPT EO BY� RATE: A.9EJ1: TANK,PIT OR 9UMP INSI`ECTiVN By OATTP 1 1 FINAL INSPECTION BY DAI E / ` ��-77 AOdT10NA1 COMMENT e: C--1-1-'OI7 S.ki V IL//T 7V (,JC�tJ+CitL SQA I� C--O7•�►'`^"�' '. ' rVlAtco( D� b b"5 IV/ 7k ACCOUNTING ONLY: NDS FACS PE CODE FEE IWO AMOUNT SEMI I TED /SOLE ASH RECEIVED BY DATE 1.0J PQIAFT NISABBI INVOICE IF z-l1 0 01 No.Health Serv.-Envko.174(3196