COMPLIANCE INFO_PR0400061 - 3910 E MORSE

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VA-T--j- � -1->=-:-Y� �- APPLICATION FOR LIQUID WASTE PERMIT N'JOAQUIN COUNTY PUBLIC HEALTH SERVIC ENVIRONMENTAL HEALTH DIVISION P,O. BOX 388, NX EAST WEBER NUE, STOCKTON, CA 95201.988 (209) 468-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (Complete In Triplicate► APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH BAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESS/OR APN#_ L►o a (Y��.S�- 1� CCITYL._a�' LOT SIZE f OWNER'S NAME �474i]"(V l 1 - Iii ADDRESS_ -'SQA t PHONE S,._ /S CONTRACTOR t n -- �*C.s�S�T'1, ADDRESS I t�l��I . �1-+r-(_u �dAN4uCI c ��T�,� P14ONE3C.- `a N3 SUB CONTRACTOR ADDRESS LIC/ PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION DESTRUCTION ❑ (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.1 PERC TEST(e►( I HOW MANY AppBoseon# INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL❑ OTHER❑ NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: 1,7NUMBER OF EMPLOYEES- CHARACTER OF SOIL TO A DEPTH OF 3 FEET: 7' PIT/SUMP SOIL CHARACTER: C-14+-Y a4,n,WATER TABLE DEPTH 6 SEPTIC TANK10REASE TRAP ❑TYPFJMFG C-e�'1��JA Pr.� CAPACrTY1 Q dJ NO.COMPARTMENTS PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL G,c"IC�' FOUNDATION SSC-` PROPERTY UNE_ UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACHING UNE ❑ NO.&LENGTH OF LINES_ `�i �( �-({) ' DISTANCE TO NEAREST:WELL2o ' FOUNDATION :2,_ / PROPERTY UNE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE SEEPAGE ATS ❑DEPTH $'/ SIZE ':3�'/ NUMBER_,DISTANCE TO NEAREST:WELL FOUNDATION /[B * PROPERTY UNE 2f SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAMB,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:•1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:•1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSN7ON LAWS OF C FORNIA.• THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. SIGNED X 1 TITLE:_ ®L`t)/1.c'rte DATE: PLOT PLAN(DRAW TO SCALEI SCALE •to 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. C 2. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. 1 ..... .... .. ... .. .. J' ... .. g _ . .. I� .. 4. © 10 . ..... . .. .. _.. .. .. .:... FOR DEPARTMENT USE ONLY '.��.Z APPLICATION ACCEPTED BY /'� DATE: AREA--'40-I—�— ANI( R SUMP INSPECTION B DATE `71AL INSPECTION BY ADDITIONAL COMMENTS: .-14 2f2 v ACCOUNTING ONLY: AIDE FAC# PE CODE FEE INFO AMOUNT REMITTED C40KNICASH RECEIVED BY DATE SR/P9iMiT NUMBER INVOICE 0