Laserfiche WebLink
APPLICATION FOR LIOUIQ WASTE PERMIT <br />ft/h <br />SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 988, 304 EAST WESER AVENUE, STOCKTON, CA SMI- 88 <br />(209) 4883420 <br />ON-AUUNDABLE PERINIff EXPIRES 1 YEAR FgqN PATt <br />Me"IN6N IN TrIPiaLr) <br />APPLICATION IS h'EREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANWOR INSTALL THE WORK DESCRIBED_ THIS APPLICATION IS MADE M COMRJANCE WITH BAN <br />JOAQUIN COUNTY DEVELOPMENT TITLE, CHAPTER 9.1110.3 AND THE STANDAROS.OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES, ENVSONME aAL HEALTH DmwjN. <br />Joe ADDRESBlOR API,• - - Z !+ f ; /errr" C_;-, �T _ nr ..x <br />OWNER'S NAME T I _ / G' ADDRESS PHOW <br />CONTRACTORT 1 Vii. 6-17100-�.ADDRESB 4J / s /-�- Uc/PHOW G%%-i•1� <br />BUB CONTRACTOR -- ADDRESS S� PHONE .. <br />TVV%OF SEMC WORK: 04EW INSTALLATION ❑ R17AJ11lAbd TLON ❑ DSiTRLICTIO <br />IND SEPTIC SYSTEM PERMITTED IF PUS2JC SEWER IB AVAILABLE WITHIN 100 FEET OF BLNLDING.I PUNC TtSTNI ( 1 HOW MANY <br />Appfle�Seu <br />INSTALLATION WILL NSIVE: RESIDENCE 0 COMMERCIAL ❑ OTHER ❑ <br />NUMBER OF UVING LAMTS: NUM0114 OF NEOEIDOMB: <br />NUMBER OF p*KOVM: <br />CHARACTER OF SOIL TO A DEPTH OF 3 FEET!._ <br />P4T7SUMP SOIL CHARACTER- <br />WATER TABLE DEPTH_ <br />SEIRIC TANIKXMFA" TRA► Q TYPEAMFO— <br />CAPACITY <br />NO. COARPARTMENTS <br />PKG TRHATMENT PLANT ❑ INSTANCE TO HSARSST: WE'LL <br />FOUNDATION <br />PROPERTY UNE <br />UFT STATION ❑ SIZE TYPE OF PUMP <br />BAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACHING UM ❑ NO, to LENGTH OF "NEB <br />DISTANCE TO NEAREST: WELL <br />VaUNDATION PROPINTY L.SOE <br />FILTER NED Q WIDTH LENGTk <br />— DEPTH DISTANCE TO NEAREST: WELL <br />_ FOUNDATION AIOPIRr y UNE < <br />MOUNDW ❑ WIDTH LENGTH <br />___. DEPTH DISTANCE TO NEAREST: WELL__ <br />_ FOIMIDATIOIN PROPERTY LINE � <br />*VrAOS PITS ❑ DEPTH SfZE _ NUMBER DISTANCE TO NEARESTr WEU__ FOUNDATION PROPERLY LINE <br />SUMPS ❑ WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPdITY LITE <br />DISPOSAL PONDS ❑ WIDTH LENGTH DF.PTFi DISTANCE TO NEAREST: WELL FOUNDATION PA10,1140" LINE <br />I HEREBY CERTIFY THAT I HAVE FWPAEED THIS APPUCATION AND THAT TRfE W01W WILL BE DONE IN ACCORDANCE -Aires BAN JOAKXIIN COUNTY OVIDWANCES AND STATE LAWS, AND RULER <br />AND REGULATIONS OF THE SAN JOAOUIN COUNTY. HOME OWNER OR LICENSED AGENT'S MONATU14E CERRRES TNF FJLLOW01140 1 CMTI YTHATBJ TIS! PERFORMANCE OF TMWDRK "WHICH <br />THIS PERMIT IS ISSUEO, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNUI AS TO BECOME SUBJECT TO WOPAMAN'B COMPENSATION LAWS OF CALL ORNIA_' CONTRACTOR'S Hwpm OR <br />M1"-COI4rRACT*M SIOFIATU RTIFTEB THE FOTI <br />LLOWING: 'I CERTIFY THAT IN TME PERFORMANCE OF THE WOW FOR WINCH THIS POWIT b ISSUED, 1 SHALL EMPLOY PERSONS SUBJECT TO <br />WORKMAN'S COMPEN�ITIO j" OF CALIFORNIA-' THE AFPUCANT MINT CA\L 34 HOURS IM ADVANCS PVAII ALL RROLWAO INOWTIONS, COMPLETE DRAWWO NELOW. <br />SIGNED <br />TITLE: r.. �'L///�/✓ rG?G DATE: <br />PLOT PLAN (DRAW TO SCALE) SCjgE ' to <br />rIALAWWRTREETS OR RDAON NEAREST TO OR BOUNDING THE PROPERTY. <br />OUTLINE OF THE PROPERTY, WITH DIMENSIONS AND NORTH DIRECMN. <br />DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED FiRUCTUREB, <br />INCLUDING COVERED AREAS SUCH AS PATIOS, DIVVEWAY9, AND WALKS. <br />LOCATION OF HOUSE NEWAOE D(W'OBAL SYSTEM OR PROPOSED <br />EXPANSION OF SEWAGE DISI OIAL SYSTEMS. <br />LOCATION OF WELLS WITHIN RADIUS OF ONE HJMMD FfM FT, ON <br />THE PROPERTY OR AD.IDIHM FROFFRTY, <br />