Laserfiche WebLink
Fri` �y Iii (ais6 , (. o <br />Q APPLICATION FOR U011IO WASTE PERMIT <br />t0 , SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH OIVISIO <br />`� N <br />�� �� P.O. BOX 386, 446 N. SAN JOAOUIN ST., STOCKTON, CA 86201-0388 <br />(208) 488-3420 <br />ON -R E PIRMIT EXF4RES I YEAR FROM DATE ISSUED <br />ICBnpIBtO i Trk&oul <br />APPLICATION 19 HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERIMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCNBED. THIS APPLICATION 18 MADE IN COLFLRANCE WITH SAN <br />JOAOUN COUNT'" DEVELOPMENT TITLE, CHAPTER 8.1110.3 AND THE STANDARDS OF SAN JOAOUN COUNTY PUBLIC WEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION. <br />JOS ADDHE9&Ofl APIId CfEY_ _ _ [ I�/T�L.�/ _LAT BRE�L� <br />OWNEW9 NAME Lu[in - /Udnc r..4 ; t -OA i �� .r nn _._.-.- --n-nx- "SIJ <br />CONTRACTOR j �i✓J , c. -5c -- Ad)iDRe96 '?:'s f';� ,G..�w..�' I�i� LIcJ PHONE <br />SUBCONTRACTOR A J4 . �GLf'O ..,.,e�ao 17a. O'�.f .. —Z/4 ,477 .._. _5 _4> , '. --_-. a.r_.« <br />TYPE OF SEPRC WORK: NEW INSTALLATION RBANUADRKi10N ❑ DSTINCTOM Cl <br />MO BEPTLC SYSTEM PERANTTED IF PUBLIC SEWER IS AVAI ABLE WITHIN 200 FEET OF BUILDING.1 <br />FY1C TtlTW r ]HOW MANY - <br />NI►JEOWon A <br />INSTALLATWNN WILL SEWS, ENCE}� COMMERCIAL ❑ OTHER ClNG <br />NUMBER OF UVUNTA: MLMSM OF BEDROOMS: NLMYI OF ENWLAYER: <br />CHARACTER OF SOIL TO ADO" OF: FEET UR�� <br />PTI$UW BOIL CHARACTER: rs,!S?Aly WATER TABLE DEPTHS <br />77 <br />y <br />SEPTIC TAMIJORKASE TRAP ® TVPEMFO' �! CAPACITY NO. COMPARTMENTS <br />PLO TREATMENT PLANT ❑ DISTANCE TO NEAPUT. WELL-dnnoy­j& FOUNDATION /% PIDPENY LINE�� <br />p1 Q <br />LIPT STATION ❑ TYPE OF PUMP L SEPARATOR IERCLOSED SYSTEM) <br />pSQE <br />LAACHM/O LINE Y NO, B LENGTH OF LWES�DISTANCE TO NEAREST: WELL PoLNDATON PROPERTY LJNE <br />fS <br />PURI SED ❑WIDTH LENGTH �_` DEPTH DISTANCE TO NEAREST: WELL '-OUNDATION PROPERTY UNE <br />HOUND® ❑ WIDTH LENGTH DEPTH DISTANCE TO NEAREWT: WELL FOUNDATION PROPERTY LINE <br />BLOPAOE PRS ❑ DEPTH SIZE NUMBER DISTANCE TO NEAREST_ WELL_ FOUNDATION FNOPETI'Y LME <br />G� <br />SUMPS ❑WIDTH {ENpTH fOEPRTN �r�L�irDISTANCE TO NEAREST: MRLI��FOUNDATON PROPERTY UNE <br />-DISTANCE <br />- <br />OMPOBAL PONDS ❑ WIDTH LENGTH DEPTH^ TO NEAREST: WELLFOUNOATON PROPERTY UNE <br />I HEREBY CERTIFY THAT I NAVY PREPARED THIS APPLICATION AMD THAT THE WOW WILL BE DONE N ACCORDANCE WITH BAN JOAOUN ODUMY O/OYUNCEB AND STATE LAWS, AND RULES <br />AND REGULATIONS OF TNF SAN JOAUUIN COUNTY. HOME OYNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOIMNG: 'I CERTIFY THAT IN THE FEM;ORMAR CE OF TIEWORK FOR WHICH <br />THIS PERMIT IS ISSUED, 1 SMALL NOT EMPLOY ANY PERSON N SUCH A MANNER AS TO BECOME SUBJECT TO WOfWAAN'S COMPENBATON LAWS OF CALIFORNIA.' CONTRACTOR'S MINING OR <br />SUB-CONTRACTNf SIGNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SMALL EMPLOY PERSONS SUBJECT TO <br />WORKMAN'S COMPENSATION LAWS OF CAUFORPBA.' TWB AFPICAMT MUST CALL G/ HIOULB N AOVA/ICB FOR, ALL REOURe, INSPWT10NS. COMPLETE DRAWING BELOW. <br />I <br />SIGNED Tftt'. <br />POT PLAN DRAW TO SCALE) SCALE N <br />1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPETry. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />2. OUTLINE OF THE r4k"VITY, WITH OMNNSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />3. OILOENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND P OPOSEO 6TAUIUS CTURES, S. LOCATION OF WELLS WITHIN RAOOF ONE HUNDRPO FIFTY FT. ON <br />INCLUDING COVERED METS SUCH AS PATIOS, ORBVEWAYS. AND WALKB. THE PROPERTY OR ADJOINING PROPERTY. <br />L EE74 io C.. ......: <br />APPLICATION ACCEPTED BY_ <br />TANK. PIT DR SUMP WSPECTON BY <br />ADOrnONAL COMMENTS: _ 1 �h{7 IJL <br />ACCOU/,IMO ONLY: NOI <br />R :Glx I FEE INFO I AMOUNT RENPTTED <br />DATE <br />ATE I t FINAL INSPECTION eY <br />ac k S W <br />FACJ <br />RECEIVED BY BATE NNR / P1VNST NUMB <br />DATE / I r Ill <br />eNS km gar <br />INVOICE* <br />