SR0082730_SSNL - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 95201388 (209) 46A•3420 NDMAEFUNDASIE PERMIT EXPIRES I YEAR FROM DATE ISSUED J _�j n© fCFRPlIt1 In Tf*Ileal v� l-C APPLICATION M HEREBY MADE TO THE SAN JOAOWN COUNTY FOR A PERMIT I O CONSTRUCT ANCA R INSTALL THE WORK DESCRIBED.THIS APP JCATION IS MADE IN COMPLIANCE WRIT SAN joApUpt COVtlYY DEVELOPMENT TFTLE.CHAJI ER 0-1110.3 AND THE STANDARDS OF SAN JOACON COUNTY PUSUC HEALTH MROCEA. rl ` ` EHVRONENT/AL(HEALTH 0MGIM JOB ABORESSRAPAP C7 CIN •SIo6 `+o-1 LOT. \ ORET■NAME 4 DEBR PONE 211- CONTRACTOR- on �,O•7 ;� AGOHEBS Ci r JN 1 UCP SUB CONTRACTOR ADDRESS lJC1 PHOMi TPR OF SVi1C WORK: NEW M/TAILRTON REPANAl1DITION❑ DOTTRNGTON❑ DIO SEPTIC SYSTEM PENMfTTEO IF FVBUC SEWER 18 AVAILABLE WITHIN 700 FEET OF RUSDING.1 PEK—TW l I HOW MANY APOInWAn!T_ INSTALLATION WILL/EWC RESIDENCE 47 COMMERCIAL❑ OTHER❑ NUARER of LIVSA UNITS:/NIAM'SEI OF BEDROOMS:_NIJMNER Of FMPLOTFYS: CHARACTER OF SOK TO A DEPTH OF 3 TEET: /PIT,SUMP-ILHARACTER' WATER TABLE DEPTH SEPTIC TANRXWLASE TRAP ❑T'PEMFO' -+ t e,-!CS MNAVACrtl 7 D LJ L'J NO.COMPA}RMENTJ Z PKO TREATMENT PLANT❑ DISTANCE TO NEA1lEL A7: WL FOUNDATION PROPERTY LINE. LIFT STATION O SIZE TYPE OF PUMP SAND OIL SEPARATOR(TWILDSEC BVBTEMI �'`� w 'r LSACMNG UNE 11 NO.S LENGTH OF LINES -/ A DISTANCE TO NFJUIEB F:WELD FOUNDATION�T!PROPERTY U/E FILTER BED ❑WIDTH LFNOTH_ DEPTH DISTANCE TO NEAREST:WELL FOUNOAT'ON PROPERTY UNE MOUNDED Cl WIOTH LENGTH T_DEPTH DISTANCE TO NEAREST:WELL PGLINDATION PRDPEKFY LINE�� 1fIPAGE NTS ClDOPTH 7 F'i I S7ZE�N 2 �HUMBER j_DISTANCE TO NFAE¢ST:WELL FOBMMTION�_FROPERry LINE IIIMPS ❑WIDTH _.� LFNGTH_`OEPTTI DISTANCETO NEAREST:WELL FOUNDATION PFOFtRTY UNE DISPOSAL FONDS Cl WIDTH LENGTH__DEPTH DISTANCE TO NEAREST:WELL 'OUNDATION PROPERTY LINE I 1 HERESY CEFTIFY THAT I HAVE REPAND THIS APFMATKTN AND THAT THE WORK WILL BE DONE IN ACCORDANCE VAT"SAN:OAGLILN COWRY OIOINANCES AND STATE LAWS'AND RLAFS AND REGULATIONS OF TIE SAN JOAMABN COUNTY,HOME OWNER OR LICENSEDAGENT'S SIGNATURE CERTIFIES THE FOILOYVNG:YI CERTIFY i RAT IN THE PERFORMANCE OF THE VAR FOR WHICFI THIS PERASR IB TERMED,1 SHALL NGT EMPLOY ANY POISON IN OWN A MANNER AS TO BECOME SUN' SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALn"ftAA.' CONTRACTOR'S MERINO OR SUS{ONFMCTNO BIONATURE CERTIFIER THE FOLLOWING:'i CERTIFY THAT M THE PEPFGRAANCE OF THE WOR FOR WMCN TMB PERMIT S,ISSUED,I EHIALL EMPANG BE PERSONS SV6IECT TO WORKMAN'S C/OMPEPPENNSATKHN LAWS OF CAUFORNIA.'' TT�HE APPLICANT MVS'.CALL 74 HOURS M ADVANCE FOR ALL"War4D MIF�E{CTN)NS. CONTESTS pMYAN6 SEIDW. BION®A / ` 3va.+.�Zz L J /V-R TITLE: L i•/T ! 1elQ\ �d✓M _DATE: ROT PLAN MRAW TO SCALE,SCALE IS I.NES OF STREETS OR ROADS NEAREST TO OR ER BOUNOTN THE PROPERTY- S.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PRGPOIED 7.DDTLNNE OF THE PROPERTY.WITH D04A 8t AND NORTH OIIIECTION. EXPANSION OF SEWAGE DISPOSAL BYBTEMS, O. DIMENSIONED OUTLINES AND LOCATION OF ALL EAISTINO AND PROPOSEp BTRUCf URE.:, S.LOCATION Of WELLS WMTMN AAOIVS OF ONE}KINl1R®FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. T 7 4 ............... .. ..... ` ............ ... : 49 k45 e D u9� ..IV . .. f Lr or r ............° ....; .. .....:........... FOR DEPAR—T USE ONLY GATE: D AREA APPLICATION ACCEPTED S'` OR BLIMP INSPECTION By �� 1 RC' I v�PINAL INSPECTION 8Y ADDITIONAL COMMENTS:I ACCOUNTING ONLY: AIDI FACA v•_ 0� �� PE CODE i FEE INFO AMOUNT RH,IIITED CHECK#, H RECENED BY DATE SA/PEI.IIT NIAMBEI lwm I Pub.HO&M Sam-Ertw.p 176(3196)