Laserfiche WebLink
-S <br /> • <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES }//_ <br /> ENVIRONMENTAL HEALTH DIVISION CJ" l7 <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)488.3420 <br /> NOWINU fDABEE PUMR ERTIRES 1 TEAR FROM DATE ISIUE <br /> 9BM*6Ln Y TToSEBIBI <br /> APPLICATION O HNREBY MAGE TO THE SAN JOAOUIN COt1MV"A PERSIA TO CONSTRUCT A40MR INSTALL THE NOCK MWAIINEO THIS APPLICATION'MADE N COMPLIANCE.MTN SAN <br /> JOAWN COUNNY DEVELOMIENT Tl.0 CHAPTER 9-11 10.7 AND THE STAMDARIGS OF SAN AAOLRM COUNTY FUBLJC HEALTH tOFV[110E•E.EM011R0IMBITAL HEALTH Oft"INO . <br /> JOB ADDREBSNR A.'N! SI 0 L t]A 9A-e-r 40 <br /> DHIIfm'f NAW A o wl A,")Ut la a wuADDREE. I q(4 01 w�m Aer sin <br /> CONTRACTOR 'IGy Inw I�[+' Aoortw N n(��� <br /> MA CONTRACTOR ADDRESS UCF FMDNE <br /> TYRE YF B WORK: NEW NETAUAIMN❑ RE•AI VAOMMIN bMTRWCTION❑ <br /> NO SEPTIC SYSTEM POI.fTTIO F PUIBLC/EWER IS AVAILABLE WRTSN MO FEET OF MADINOJ ANI.TESTIS 1 1 MJt►MANY <br /> NSTALLATON YRLL SONE: REWENCcQ COMFAEFKIK(--) OTHER❑ <br /> IISAM OF LIVNO UMTS:_NMWAOI or■NMOOMSa MIBrER OF IIPtDYYS: <br /> CHARACTER OF HOE-TO A DEIRN OF J FQT:��j Ad_ _RTARSAP SOIL CHAPACTUI: WATER TABLE DErTI[_,_ <br /> SEPTIC TANRAMfASE TRAP ❑TYF6MFS CAPACRY NO.COMPARTINTB <br /> PRY TRSATNIOTT RANT❑ DISTANCE TO WARMT: WELL FOUNDATION PROPERTY LINE <br /> UFT STATION❑ JIM TYPE CF MEP SMT OIL SEPARATOR ENCLDSEO NVETUJI <br /> LAAOHOIS LINA ❑ NO.B Lamm OF tMEB DISTANCE TO NEAREST,WELL FNNNDATION FIRM"" <br /> UNE <br /> PSTN SEE, AWOTH �� L[)ON3� O►N r1 PUlTDFAFL= PRPORY <br /> LAWS <br /> NIORADED ❑WDFH LEND TH__`DEPTH DISFANCE TO NEAREST:WELL FCUNDATRIN PROPLTRV LINE <br /> B@Aa FRE ❑DEPTH am _MAOM DISTANCE TO IEAft":WELLiVINDATON PROPER—LINE <br /> SIMS ❑1MDTN LODTH T DEPTH DISTl1110E TO IEA/EST:LAIELL ,�POIBRDATION PTDPlRTY UIL <br /> OISPOYAL PONDS ❑WIDTH LMIGTN DLTRH DISTANCE TO NEAEST:WFLL__F'01MDATpN PIOFEAFY LM <br /> — <br /> I NEIEBY CU FY THAT I HAV[PREPARED THIS APPLICATION AND THAT THE WOFA WILL SE DONE IN ACCOROANCII WITH PAN JOAOON COUNTY OIDNANCES RANO STATE LAWL AID RUES <br /> AND RATIO IS OF THE SAN JOAOUN COI/MY.MOM OWNERORUCENSEO AOENT'S SIGNATURE CEKrWRO THE FOLLOWIN0:'ICEIRFYTHAT N M RDSORBLO'"OF THE WORK fORWgCN <br /> TNM POUR M IGIG1EO,I MULL NOT EMROV ANY PERSON N SUCH A LIMUER AS TO BECOME KRUECT TO WOMAWff COW"MILATION LAWS OF CALIOARA'CONTRACTOWD WOW OR <br /> Kill-CONTRACTING OONATUIE CERTIFES THE FOLLOWING:1 CERTIFY THA'.'N THE PrWORMANCE OF THE WORK PO!4 W IC H TUM AFIMKT 0 WI URI.1 MSALL E►ILOY PERSONS W§JWT TO <br /> WOFKAUW'S COMPENSATION LAWS Of CALIFORNIA.' THE APPLICANT MUST CALL K HOURS IN ADVANCE POR AU.IEOIMEO BISFLFMNS.COULEES DRAWING BELOW <br /> mover,x 1AAllralJ 7 0[� T,TLE,f nn 1 C�4 0 DATE:j <br /> PLOT PLAN WAW TO SCA4E1 SCALE -N <br /> I. <br /> NAMES Of STREETS OR RDADOI <br /> S NEAREST TO OR BOUS NO THE PFOPOITY. 4.LOCATION OF HOUR MWAYE OOIOSAL WMEIA OR PRIX"m <br /> 2. OUTUNE OF TE NOPERTY.WITH DIIAD MONS AND NORRR DIRECTION. 9"ANODI/OF SSWAI E DISPOSAL SYSH9JS. <br /> G.OIMENKORM OIRIIES ANO LOCATION OF ALL"ISTNO AND PROPOSED ETRUCTME4. E.LOCATION OF WELLS WITEON RADRAS OF ME HUMMED FIFTY FT.ON <br /> NCUPOR O COWPM AREAS SUCH AS METS,OFTWWAYS,ANO WADES, THE PTOPERTN OA ADJOIfIB FIOPENfY. <br /> ......... ..... .. .. v .. - ... <br /> .. - <br /> .. .... <br /> a <br /> ... 1 I. .. .. ... ..... _ <br /> V- Qb of <br /> 61 <br /> ....F� .: ... <br /> .0.... .r..... . . ,. . ....... . . . ....... <br /> .........:<. .:.° <br /> ....... <br /> .. _ <br /> o <br /> s r <br /> :................ . <br /> T <br /> pry1610L'�. . <br /> (in <br /> y�� C\{ NOR YrARISMUSE B ONLY <br /> APPILCAT10N ACCEPTmN V JA as N l OATS: - _ MG: <br /> TISK,PR OR SHAM BPBPECn0P1 BY /YE DATE U / FINAL INSRCTON BY DATEI I ,S A 9 9 <br /> ADWEINAL COM HTB: <br /> ACOOUNTIFA ONLY: ADI FAC! <br /> M COFiE Ft ONO ANgTNT RDWN ITfD lCASN RIYHYeb BT DATE Mt/PESHIT NIIMYL IFVOHC!1 <br /> Pub,H-Aft SBIv.-Envlro.174(WW C ,12 0 -T ( ayl <br />