SU0003874 - Laserfiche WebLink

Home Browse Search

APPLIIC� FOR LIQUID''WASTE PERMIT S4'3 JOAQUIN C�it3',.T I X Hif1O 1NTY PUBLIC HEALTH SERVICES l c11 I'a{ -' FO••`` •` -" ' ' ` AVIRONMENTAL HEALTH DIVISION RU.;BO)( Bt--145 N.SAN JOAQUIN ST,STOCKTON,CA 95201.0388 JL (209)468-3470 2r„sf •�.. NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complot{in TrglLut{l APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED.THIS APPUCATION IS MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESS'I'O�fl�'''A/P�N._L5 �_ q �/' -11 O �/.[�(''('l, , 1,� r� — rl,/�� ('�)� CSG M LOT SIZE OWNER'S NAME l 1 i�` 7' - E1 m 1A g Q ADDRESS ' gqf J I A�T��1.�Iy�\JJQ/� F�1CJl.- PHONE`l`"(�� 5 ) CONTRACTOR PQdu)!'.l 1 S6��Q1,.SI C-'LC.lrlj o.!'-f- LICL�5 PHONE, 2 6VB COMRAC 1 — ADDRESS UCI PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION❑ RE AIR/ADDITION DESTRUCTION❑ WO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TEST61 I 1 HOW MANY AppH.Eon t INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL yE OTHER 13NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:/\ NUMBER OF EMPLOYEE{: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANIUMEASE TRAP ❑TYPE/MFG CAPACT' NO.COMPARTMENTS PKO TREATMENT PUNT❑ DISTANCE TO NEAREST: WELL FOUNDATION rROPERTY LINE LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEECHING UNE ❑ NO.i LENGTH OF UNE6 DISti AHCE TO NEAREST:WELLFOUNDATION PROPERTY UNE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL POUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE SEEPAGE PT{ /,yp��/DEPTH /l !SIZE NUMBER `,DISTANCE TO NEAREST:WELL ,�C�//F-O•UNDATION �FROPERTY UNE SUMP{ 'LI WIDTH-"�'LENGTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISPOSAL POND{ ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION 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 LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THEFOLLOWING:'ICERrIFYTHAT IN THE PERFORMANCE OF THEWOW FORWHICH `. THIS PERMIT IS 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 PPOryLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF C)W IA..'THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS.COMPLETE DRAWING BELOW. y— II SIGNED x `J TILE: DATE: PLOT PLAN M TO SCALE)SCALE •to f 1.NAMEAETS Z-A DSNEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2.OUTLIROWITH DIMENSIONS AND NDRTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. -SRCLO D'JUtEA&3UGH'A9TRrn7es:'G.TiL9TRry`ArusOatccn--TURES. !.RV'.�r_rnOc wp!s wRrHw.RADIUS OF ONE HUNDRED FIFTY Fr.ON fV :.. lee 1 • Y ° �oi� ........... } CN F SI ••••..•.•` .- y'1 �/ /�'r'R FOR DEPARTMENT USE ONLY' rA Q APPLICATION ACCEPTED BY �( PLA AL( lir-n DATE: `S' _(a-I AREA: 1T(� o TANK,PR OR SUMP INSPECTIONS DATE / / FINAL INSPECTION BY 9 DATE n ADDITIONAL COMMENTS: �c7 [ink 1!� oVQ✓ reoni(✓ 14 �4 a-,A 0. 0,1 Ctc(yr k ed _ ACCOVNTINO ONLY: NDS FACA PE CODE FEE INFO AMOUNT REMITTED NEC KASH RECEIVED BY DATE SR I PERMIT NUMBER INVOICE S y. ) oai5r