SR0079711 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O.BOX 389, 445 N.SAN JOAQUIN ST.,STOCKTON,CA 952010388 t209t 4993420 NON.REFUNDABEE PERNFF EXPIRES 1 YEAR FROM DATE ISSUED MamPlEh in TrW—tat APPLICATIGN IB HEREBY MADE TO THE BAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCHIBED.THIS AP-ICATION IS MADE IN OOMPUANCE Y,frH SAN JOAQUIN JOB ADDRE88lO:1 ApNE LOPMFJN7 TRIS,CHAPTERS-1110.3yANDTHE BrANDAATlB OF BAN JOAQUIN COUNTY PUBLIC�IT`lMTH SERVICES.�RONMEHTAL HEALTH DIVISN)NO.T� f(>, � OWNEA'S NAM( ..--•• 1 D51 I ADDRESS !7 Q J�/�Sym f�� J•PHONE_ CONTf1ACTOR_ Y/�IL±h ADORES& '7 O O � [J V !IJ..I JLIGa _3Qj��FHOIE 9��.5�a•-� 8V8 CONTRACTOR ADDREBS LICE PWONE TYPE OF E WORK NEW INET AlUT1ON Ell REPAET/AODITION❑ DESTRUCTION❑ (NO SEPTIC BMW PERMITTED iF PUBLIC SEWER 16 AVAILABLE WITHIN 200 FEET Of BUILDING.) P9EC TEA N)I I NOW MANY ,.�. � APPYeA f_ INSTALLATION WILL SEROUS: RESIDENCE L--COMMERCIAL❑ OTHER❑ NLEMYI OF LIVING UNITE:/NUMBER OF 11MADOMS: NINi591 OF EPIEROYEES: CHARACTER OF BOIL TO A DEPTH OF 3 FELT: Mf6UNP OIL CHARACTER: WATER TABLE DEPTH SEPTIC TANK/OPWAEE TMPI3T�FriMFO CAPACITY NO.COMPARPNI'm e - ►KG TREATMENT PLANT❑ DISTANCE TO NEAREii: WELL FOUNDATION IigPE1TTY UNE - -- LIFT STATION❑ BITE TYPE OF ROMP BAND OIL SEPARATOR(ENCLOSED SYSTEM( _ I LEACHING UNE &-N&A LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROKRTYUNE FILTER SED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNCATm PROFFRIY ME- SEEPAGE MOUNDED WIDTH LENpiH DEPTH DISTANCE TO REAM67:WILLFOLINDATTDN PROPERTY UNE (00C� SEEPAGE PRE ❑DEPTH SIZE NUMBER OCUTANCE TO NEAREST:WELL KILNDATION PIIOfFRi`l UNE W SLIMPS ❑WIDTH LENGTH__DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE DISPOSAL POND# ❑WIDTH LENGTH _DEPTH DISTANCE TO NEAREST:WEU--FONRDATION P PEPTY UNE I HEREBY CEKFIFY THAT I NAVY PREPARED THIS APPLICATION AND THAT THE WORK MILL BE DONE IN ACCORDANCE WITH BAR JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LI TENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:•I CER IFYTHAT INTONE PERPDPaEA,CE OF THE WOW FOR WHICH THIS PERMIT 1S ISSUED,1 SPALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LA11V8 OF AUFOPWI/L.' G'TTPTTRACTOR'E HMNNG OM1 ' SUB RACTNG BIGNATVRE CERTIRES THE FOLLOWING:7 CERTIFY TIAT IN THE PERfORMANCE OF THE WORK FOR'NYHK:H TMIB PERAIR W ISSUE I SHALL EIARDY PERSONS SUBJECT TO WORK O U 6 OF LFORN_ 77 APPLKAM MUST CALL_/IOW IN ADVAE FOR ALL REGLMm HIEF�TIONIL C DRAWING BFI OW. _S ~ i slc RAT RAN IDI TO SCALE)SCAE TA - I 1.NMC&OP STREETS OR ROADS NEAREBT TO OR SOUNDING THE RPOPERTY. 4.LOCATION OF HOUSE SEWAGE DIEP06AL SYSTEM OR PROPOSED 2.0UTUNE OF THE PROPERTY,MTTH DIMENSIONS MIO NORTH DIRECTION. EXPANSION OF SEWAGE DMfOSA SYSTEMS. 3.0FOXNSIONED SUTURES AND LOCATION OF ALL EXISTING AND PRDPOBED STRUCTUPES• S.LOCATION OF WELLS WITHIIN RADWS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIO.,O I VEWAYS,AND WAXB. TPE PROPERTY OR ADJOINING PROPEATY. ID,000 �I IT 571 : �.d_I 1 ...... ..... ............. .. < : I ..`. E 1 4 1 ....� _,..... . ..:............ ...... : a' NMENTAt HENJ f... .........._.. . LN�1 f FF�raL�l.s. ?�tiC�s .. 35l.r......... ;. . .. ....> ..... ..... _.......... ...._....... ............................................ .................. ......:..........::.... ......... ...... .'.. i... . ......... r.... ..... ..... :.. ..... I . I FOR DEYARTIM LME ONLY APPLICATION ACCEPTED BY t DATE:•_. `Y .VEA: V";L- -, T I MN K,PfT OR BULIP INSPECTION BY DATE ! I FINM INSPECTION BY DATE.2, ADU!TUNAL COMMEh TS: ACCOUNRIG ONIV: AIDE fAC0 ECDF$INFO AMOUNTIED CIECKf ASN I RECEIVED W I DATE ER I—IT NIJMEOT IMVOIOE Tqr3 7 li��