Laserfiche WebLink
APPLICATION FOR LIQUID WASTE PERMIT <br />SAN JOAOUIN COUNTY PUBUC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 466-3420 <br />NOWNEFUNOADLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />1C446u iB TRjllkato) <br />APFC CATION IN HEREBY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDDR INSTALL THE WORK DESCRIBED- THIS APPLICATION 14 MADE N COMPUANC!z WITH BAN <br />JOAOUM Cow" DEVELOPMENT TITLE. CHAPTER 8-1110.9 ANO THE STANDARDS OF SAN JOAOLRN COUNTY PUBLIC HEALTH SERVICES. ENVSOMMENTAI HEALTH -VISION. <br />JDs ADDREMJOR AqU Rn q A /1 [ E A ver . n CRY_ , a �� q yyG LOT SIZE <br />oWNul•a NAME 4l,Q,¢ �.,�e u �� C ADDREss !` /� c x 2 Z !2 /7 <br />CONTRACTOR Oa ADD11E66 7 L1CI6 9__,_ rcr 4 PEIONE S �rf `p <br />SUS CONTRACTOR ADORE" LCF F.IONE <br />TYPE OF SEPTIC WORK: MEW MSTAUATION IIFPASUAOORION ❑ OEITRUETNIN ❑ <br />BJO SEPTIC SYSTEU PEFWRTED IF NRBLIC BEW FA IS AVAILABLE WITHIN 200 FEET OF MMLDINO.I KWIC TBSTHI I I NOW MANY <br />CIL �APFBo4Nw �� <br />UUTALLATION YYIIL SHIVE: RESI0ENC8 p COMMERCIAL ❑ OTHER ❑ <br />INNPLTL OF UVNG IMTS:­,L_ NUN ER OF BEDROOMS: 2 NLASIBI OF PAMAY[D: <br />CHARACTER OF VOL TO A DEPTH OF 3 FEET: PT/BI11.P EOIQEI L4CTER, WATER TABU DEPRt_ <br />4SPfK TANK/OIIEASE TRAP ❑PE/I.I <br />TYTO 5 1 �, SC CAP,, Y'7�I CAP,, i _ ,�O _ NO-COMPARrumTS V , <br />PKD TREATMENT FLINT Cl ONTANCE TO NEAREST: WELL .rT7 FOUNDATION PROPERTY LINE <br />UPT STATION ❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR ENCLOSED SYWEMI <br />LSACISNG ME ❑ NO. E LENGTH OF LNES— DISTANCE TO NEATEST: WELLFOMDATIDN PROPERTY ME <br />Film BED a WIDTH ' LENGTH1DEPTN,lg:�_ d4TANCE TD NEARER; WELL�L ] FON/OATION PROPERTY LINE <br />MOIINOLD ❑ WIDTH LEN(rTH__DEPTH DISTANCE TO NEAMET: WELL FOUNDATION PROPERTY LINE <br />SEEPAGE NTS ❑ DEPTH SRD: NUMBER DISTANCE TO NEAREST: WELL FOUNL/ATIW PROPERTY LN[ <br />SSA►S ❑ WYDTN LBDTH _ DEPTH DISTANCE TO NEAREST: WELL__ FOUNDATION PIOPERIY'LNE <br />ASROSAL PONOS ❑ WIDTH LENGTH- DMH DISTANCE TO NEAREST: NIELL__ FOVNDATTDN PROPERTY ME <br />1 HEREBY CERTIFY 7RAT 1 HAV! PREPARED TMG APPLICATION AND THAT THE N W WALL Y DONE IN ACCORGAN WIH 2AN JOAOUIN COUNTY ORDINANCES AND RATE LAWS, AND IDLES <br />ANO WOULATIONS OP THE BAN JOAQUIN COUNTY. NOME OWNER ORUCEVSED AGEW'S BIONATUNE CErtTNEO THE FOLL.OYYNS: -I CERTIFYTHAT M THE PBEORMANCE OF THEWO/K FORY4RCH <br />THIS P[RLNT IS ISSUED, I SHALL NOT EMPLOY ANY PBNON N KI01 A MANNER AS TO BECOME MJISJECT TO WORKAMNTB COMPENSATION LAWS OF CAUFORNIA.' CONTRACTOR'S MOWN OR <br />SRI-CONTRACTSM @MATU E CERTIFIES THE FOUM V040: '1 CERTIFY TTM',' IN THE FFNFawAANCE Of THE WORK F04 YMSCH THIS PERMIT M MBUEM I SMIL SNEPLOY PERSONS SUBJECT TO <br />WOP[MAN'S COMPENSATION LAWS OF CALIFORNIA-' THE APPUCANT MUST CALL M HOUIUI IN ADVANCE FOIL AU. IERIEI D NSRGt10NB. COMPLETE OMV NG BELOWn. <br />SIGNEDTTTLE:1.1 L� ii C�-K __ DATE, <br />PLOT PLAN DRAW TO SCALE) SCALE- - - - / <br />1. BW STTEETS OR ROADS NEAREST TO OR BOUNDING THE PROP[RTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />Z. OUTLINE OF THE PROPERTY. WITH DIMENSIONS AND NORTH DNECTIDH. E XPANE ON Of SEWASE 044POML SYST9/8- <br />3. DIMENSIONED OUTIINE4 AND LOCATK OF ALL EDSTNO ANO PROPOSED STRUCTURES. S. LOCATION OF WHLS YVITIIRN RADIUS OF ONEHUNDRED NFTY FT. ON <br />INCLUO M COVERED AREAS SUCH AS PATIOS. DRIVEWAYS, AND WALLS. <br />W¢1t <br />... <br />...... <br />�.c. us e L .... <br />...... ....... :.. <br />...:....:............... ....... <br />.. .. <br />`vim. .. ........ <br />.. .. ... _. <br />1 <br />Sf.N JaJ,C[iiN'CUL'I"'.T........... <br />EnLf45 <br />•.� cTfrr.l .IK'�, c. <br />APCATON A PIED <br />RI <br />.. .. <br />`vim. .. ........ <br />.. .. ... _. <br />1 <br />APCATON A PIED <br />RI <br />{� iM D <br />BIT LME ONLY <br />DATE. <br />TAMC, PIT OR SUMP MSFfCTION BY <br />DATE <br />l / FINAL NBPECTION W <br />ADDITIONAL COUMBRS: <br />AEEeIINRNO ONLY: AID/ fAC/ <br />PL EOUf FEE NFO AMOUNT NEW I T CIB ASH RECEIVED BY DATE N N PBMfT P LRAM IJIVOIC[ • <br />Pub. HISS" SBH. • E nviro. 174 (3M) /� ,A / /J J/ �� 3 G f (/ S <br />