Laserfiche WebLink
APPLICATION FOR 1.10010 WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NON-REFUNDABEE PERMFI EXPIRES I YEAR FNBM BATE ISSUED <br /> mamplSTS IN TR}R1*t■I <br /> APPLICATION IE HEREIY MADE TO THE NAN JOAQUIN COUNTY FOR A PERIMIT TO CONSTRUCT AMIOR 0-TALL THE WORK DESCRBED.THIN APPLICATION N MADE N COMPLIANCE WITH BAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLES.CHAPTER <br /> �9-1110.3 AND THE STANDARDS <br /> /OF SAN JOAOUM COUNTY PUBLIC HEALTH eER1 cEEJ■.fMV11gMEEEMAL HEALTH DrVMOM. l <br /> JOB AODREBaR APNI �G]( r.�'7 kf i T/! Cm ITC/QG LOT erz[_ ` <br /> b <br /> Abbneee PONE <br /> OWNER'*NAME ) n _ <br /> coHrRAcroa �.�. –UGG�rI� ADORE80. �7/� 6 ?Jyieo P _Llcr ProNE-inEy--2rl <br /> L'IM COMRACtOR ADDREBN me PTiOME <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION Q IEPAWADOITON DFMTNJCTIOK❑ <br /> LINO SEPTIC SYSTEM PERMITTED IF P BUC SEWTR 10 AVAILABLE WITHIN ZOO FLTT OF*USLDINO.I PTHC TORTN)l 1 MOW MANY <br /> Aipli-t-r <br /> INSTALLATION WILL NTRVE: RESIDENCE COMMERCIAL❑ OTHER❑ <br /> NUMBER GP LIWNG IIHITS:-�-WANNER OF■mROeMt:�_NUMam Of wrtDYQI: _ <br /> CHAAACTER OF*OM1 TO A DEPTH OF 3 FEE: nl.?r PTIBUMP BOIL CHAMCTER: WATFR TABIJ<DEPTH <br /> SEPTIC TAMJORSANS TR[RA---PII ❑TYPVMFO CAPACITY NO.COMPARTMENTS <br /> PRO TREATMENT PLANT Ld DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> tort STATIM 11 (EN <br /> SIZE TYPE OF PUMP *AND OIL SEPARATOR CLOSED*Y■TEMI F� _ <br /> LEACHING LINE RO.*LENGTH of LINES //-IV/-t DISTANCE TO NEINESTi WYEL�� PNOFERTv LINE <br /> TITER SW ❑WOrH LENGTH DEPTH INSTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH D"TH DISTANCE TO NEAREST:WWELL FOUNDATION PROPERTY LINE <br /> ■®AGE PTS ❑DEPTH a n NUMBER DISTANCETO NEARESTi WELLFOUN12AYMN PROPERTY LONE <br /> SUM" ❑WIDTH LENGTH OEPTN DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> p1PO1AL PONDS ❑WIDTH LENGTH OEPIH DISTANCE TO MEANEST:WELL NOUNDATIOM PROPERTY UNE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOR(WILL BE DONE 1N ACCOIOANCE W"SAN JOAOUN COUNTY ORDINANCE*AND STATE LAWS,AND 1MEe <br /> AND REGULATIONS OFTHE SAN JOAQUIN COUNTY.HOME OWNEHORLICIN*ED AGEHT^S■10KATURE CERTIFE*THEFOLLOWINO:I CERTWYTHAT INTHEPEP`ORMAMCE OF THEWOIK NORWICH \ <br /> THIN POLAR IS MNUED,1 SHALL Not EMPLOY ANY PRISON N SUCH A MANNER M TO SECOMF SUBJECT TO WORKMAN'S COMPENNLTION LAWS OF CALNVIV IM'COWAACTOR'1 HII*HO OR <br /> "-CONTRACTING OGNAtURE CERTVIE*THE FOLLOWRNO:I CERTIFY THAT N T/E PESOgAANC[OF THE WOW FOR WHICH THIS PERMIT HI 1*SUFD,1 SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA."THHR AAPPP]CMCALLMN <br /> T MUST Cl ZA HON ADVANCE FOR ALL REOU NN"INSPWTIORS. COMPLETE ORAWRNG SEIOW. <br /> S10MED X /r• L.iC.!!/ TERE: .GJLIP� �.: DATE <br /> PLOT PLAN IORAW TO SCALEI SCALE "I- <br /> 1.NAMES OF STTEETI ON ROAD*NEAREST TO OR BOU NOM THE PROPERTY'. M.LOCATION OF HOUSE SEWA01 DISPOSAL SYSTEM OR PROPOSED <br /> Z.OUTLINE OF 771E POPERY.WTTTf DIMO/SgNN ANb NORTH OOECTgM. EXPA1SKH1 OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DMF11W ED COMME*AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, f. HE PROPERTY <br /> T WR A WITHIN PROPRADIUS Of ONE IIUNOI®FIFTY FT.ON <br /> NLIUOSO COVEIIO AMEN SUCH At PATIOS.DRIVEWAYS.AND WALKS. TRI!P1IDPERTY OR ADJON/SIO PROPERTY. <br /> ay G�au!E� <br /> C <br /> �;► � . <br /> .... <br /> v Ai �tL <br /> .... <br /> j:..... ............ <br /> :. <br /> _..v. <br /> r <br /> i. ... SbF .... ._ <br /> AY{1LN� <br /> �Fc,, ,1.,d —T- C�EIVE0 <br /> /r!'. _ <br /> 3 Q <br /> . : ... PU EIC HFACTH SERVi ES <br /> IOM_DVAItTMFMT U1E ONLY <br /> APPLICATION ACCEPTED BY DATE - ^: <br /> TANK.PR OR Sl1MP NIBI--/[P�IECigH BY / may, 1DATE I I FINAL INSPECTION BY DATE <br /> ADOITIDNALCOMMEHTB-3`gfj&Lb -r pl� E �" LN!^v l <br /> ACOOUNTINO OMY: ND/ FACT <br /> ►!COBE FOO" OUNT IUMITEO DATE M I PEANUT NUMBER INVOICE S <br /> a o LN <br /> Pub-Health Saw--Erlvlro.174(3M) / <br />