SR0081577 SSNL - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH 5fBY10ES dig ayg.6 ENVIRONMENTAL HEALTH DIVISION P,O.BOX S88,904 EAST WEBEA'AVENUE,STOCKTON,CA 95201388 12091482-3420 NOWREFUNDA@LE EQUIT EXPIRES f YEAR FARM DATE 1S811ED IDGmPL1S It Tr*rx.f4) APPLICATION IS HEREBY MADE TO THE RAN JOAQUIN COUNTY FOR A PEWJR TO CONSTRUCT AIA(OR INSTALL THE WOW,DESCPoBED.THIS APPLICATION Is MADE W COMPLIANCE WITH BAN JOAQUIN COUNTY DEVELOPMENT TIT(L�E,CHAPTER 9,1110.3 AND T)HE�VrAHOARDR OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH OVASION, JOB ADDRESS"AJ/PPNP LSI((�J \y1� � IY�(j,+(/+Y-� R� � ,.` CCIITTY��1"C�P COT BIZ C OWNER'S NAME�} `T IJ^ �L �Sj ��.�`/I/�'w"'^ CONTRACTOR E'<1 11 6-rf)S Y C-Y ��ADDRESS I Sl ay.�f/ L.� NL^�'1UC! SUB COM'RACTOR ADDRESS LICI PHONE TYPE W SEPTIC WOR%: NEW WSTSLCATION❑ RWAIRfADGITIO 1DI'JTROC7IDM❑ IND SWIIC SYSTEM PERMITTED IF PUBLIC SEWER 19 AVAILASLE WITHIN 700 FEET OF BUAoINDAI FERC TEBTUI l 1/IOW MANY APFdo/tlm/ INSTALLATION WILL GOWL, RESIOFNCEA COMMERCIAL❑ OTHER❑ NUMRBI OF LIVING UNITS:--�—RUMMER OFBEDROONI6: _NU,Q9I OF EMPLOYEES: G CHARACTER OF SOIL TO A DEPTH OF 3 FEET: .J ar l V PTAUMP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANKlOPEASE TRAP ❑TYPEIMFO CAPACITY NO.COMPARTMENTS O PKO TREATMENT PANT❑ DISTANCE 70 11CARE17: WELL FOUNDATION PROPERTY LINE ` LFT STATI W❑ SIZE TYPE OEFTH ��OF PUMP SAty01lR 6EPAAA700.(ENCLOSED SYSTSYSTEM UTACNNO UNE DJd6-aI Ck7 NO.ALENGTH OF LWES y.r e Ao T_DISTANCE TO NEAAEaf:WELL�TFOUNDATION PROPERTY LINE /AL RLTIN SED LENGTH _ DISTANCE TO NEAREST:WELL_ FOUNDATION PROPERTY LINE_ (`/} MOUNDED ❑%LOTH LENGTH OEFTN DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEWAGE RTS ❑DEPTH BQE NVMBER DISTANCE TO NEAREST:WELL FOUNOATTON PROPERTY(INF ( -1 StAMPS I❑-I WIDTH LENGTHY/J DEPTH _DISTANCE TO NEAREST:WEIR W RDNNDATRDN �lrD PROPERry UNE _ V a1POSAl ronw LI WIDTH LENOTN DEPTH DISTANCE TO NEAREST:WILL FOVNRATPR PROPERTY UNE S�x 8 C •`�- 1 ND MeESY CERTIFY THAT I HAVE PREPA F ZIC DONE IN ACCORDANCE WITH SAN JOAGUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES ' AND FSEOULATIONB OF THE SAN JOAQUIN COUNTY.NOME OWNER OR CENSED AO IONATUIE CERTIFIES THE FOLLOWINM:•I CESTRFYTHAT IN THE PERFORMANCE OF THE WORK FORWHICH (� THIS PERMIT U ISSUED,1 WALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SURJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFOLWIA.'CONTRACTOR'S I41FWG OR T'1S SVBi'OHfR/tC71N0 MUNATURE CERTIFIES THE FOLLOWIN 'Y CERTIFY THAT IN THE PEAFORMMICE OF THE WORK FOR WHICH THIS PERMIT t6 ISSUED,1 SHALL EMPLOY PERSONS SURlED7 TO WORKMAN'S COMPENSATION LAWS OF C7 A.' ANT MUST CAW,24 HOURS IN ADVANCE FOR ALE IMMERSED INSPECTIONS.COMPLETE ORAV"O BELOW, TTRE:��,G U DATE: C�l Fi7OlI X '�L"�W OT (DRAW TO SCALE)SCALE `to 1.NAMES OF STREETS OR ROADS NEAREST TO OR B THE PROPERTY, 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM DR PROPOSED 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 'T DIMENBONED OUTLINES AND LOCATION OF ALL EXISTING AND fFOPOSED STRUCTURES, S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED RFTY FT.ON INCLUL NO COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS, THE PROPERTY OR ADJOINING PROPERTY. V ,: qq O0 N 1` x�p Ixs 14 d ........... ,L F U � : .. p<a FES 519 l 9? ± Ary' ' HfA7 YW SfiRC1iCES ...... .. ... ,. ..:. ............ .. .... ........ . . _. X1;4"' ONkg .._. f�/Q.MLY^k FGR DEPARTMENT USE ONLY RANK. ACCEPTED BY- r-�L_t V DATE: ! / AREA: TANK, OR BUMPINBPECTI011 BY DATE ! 1 FINAL INSPECTION BY DATE !J/ 14� A COMMEMe: ,.l{.� /4 ACCO ACCO NO ONLY: WD/ FACT PE DF PEE INFO AMOUNT REMIfT@ CHECK/ ASH RECEIVED a, DATE w I PFISYIT NIMBl1/ INVOICE• 42-Pua 142— Flub. b.Heahh 8erY.-ErWIrD.174(3/9B)