Laserfiche WebLink
APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'Jj `�UIN COUNTY PUBLIC HEALTH SERVICES <br /> ``-41RONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 446 N. SAN JOAQUIN ST, STOCKTON, CA 96201.0388 <br /> Fill <br /> (209)468.3420 <br /> NON-REFUNDABLE PERMIT EXFIRES YEAR FROM DATE ISSUED <br /> (c mpl.te h1 TripG tm) <br /> 'ONS HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> COUNTY DEVLIDPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUITN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH OMSK„N. <br /> �RESSAOR APNf �7 _ <br /> w►ME�U /t h S crry LDz SIZE <br /> - <br /> r f 1�r At>oREss n D PHor (o7—�/r 706 <br /> I:TOR_ / �. LL.� r1OI Y S�� ADDRESS oC D L1Cf PHONE I /Z06 <br /> TRACTOR 01 <br /> r <br /> ADDRESS S LCf PHONELy= C <br /> 1 <br /> s�rlc WORK NEW r"TALLAIIOMA13 REPAR/ADDITION ® DP6TRLICTeoN!] <br /> I <br /> IC SYSTEM PERMITTED IF I'UBLJC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDMJ PMC TESTW t I NOW MANY <br /> App/oadow f <br /> FIT10N WILL SERVE RESIDETICF* COMMEA m❑ OTHER❑ ••�� <br /> �..OF LI111N0 UIQrf: NWARIE 1 OF BEDROOM&:_ �NUMBER OF 94P OYEEf: t�QOG/� <br /> rER OF SOLI.TO A DEPTH OF 3 FEET: �j /PIT/SUMP SOL CHARACTER: WATER TABLE DEPTH <br /> 8 �J f <br /> TRAP TYPE MFG � <br /> Y �( 2&�CAPACITY CJ// NO.COMPARTMEMS OC <br /> IF;Tmw <br /> PLANT❑ DISTANCE To NEAREfT: WEL2, / FOUNDATION �D - prmony Lam :5A7 "f~T STATION❑ SIZE TYPE ,f / SAND OL SEPARATOR 0KJOSED SYSTE Q <br /> ' 7 UNE ❑ No.a LENGTH of LINES '/j'�[/�,( DWANCE TO NEAREST:WELL FOUNDATM,/,4 :2[ PROPERTY UNE <br /> D ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATXM r, PF M13ITY Ui�� <br /> LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> Rif ❑ SIg 3�„!• NUMBER DISTANCE TO NEAREST:WELL�FOUNDATION PROPERTY UNE <br /> ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LRNE <br /> CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOWN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> 1LATIONSOFTHESANJOAOWNCOUNTY.HOMEOWNNERORLICENSE15Af,BtTSSLGNATVAECERTIFiESTHEfOUOVVp10:'ICERTiFYTHATWTHEPFfiFORIJANCEOFTHEWORKFORWHK:H <br /> AIIT tf ISSl1ED,1 SHALL N07 EMPIOY ANY PERSON tN SUCH A MANNER AS TO BECOME SUBJECT TO WNORKAL/W S COMPENSATION LAWS OF CALFORIOA' CONTRA►CTOWS HIRING OR { <br /> TRACTINO SIGNATURE CERTTREB THE FOLLOIMNG:'I CERTIFY THAT W THE PERFORMANCE DF THE WORK FOR WHICH THIS PERMIT 1818l;L1R)I SHALL EMPLOY PERSONS SUB ECT TO <br /> J/'8 COMPL7LSATIOt1 tAWS OF CAUPORMA.' THE APPLICANT MUST CALL 7+t NOURA IPI ADVANCE FRsk ALL t RiSP6CTtONf. COLApLETt:ORAWWLL BELOW. C <br /> y m DATE:__ <br /> c <br /> PLOT PLAN Wmw(To SCALE)SCALE to C <br /> S OF STREETS OR ROADS NEAREST TO OR BIM0010 THE PROPERTY. 4. LOCATIDN OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> INE OF THE PROPERTY,N WITH 01MENSIOM AND NORTH DIRECTION.. plp SEWAGEF SAL S TS1rSYSTEMS.*SYSTEMS.*F <br /> WOD OUTIJNF2 AND LOCATION OF ALL EXLSTTNO AND PROPOSED STFUCRJRES. 6. LOCATION OF NEMS WITHIN ONE HUNGERED FIFTY FT.ON <br /> aim COVERED AREAS SUCH AS PATIOS,DWVEWAYIS,AND WAIKf. <br /> ................................, ::,:..... <br /> THE PROPERI V OR ADJOINING PROPERTY. <br /> .... ..... .. <br /> ...p.....i......y.. .. <br /> ..a... <br /> .�.... ......i.......j......?..... .,.... <br /> v;... ...y... ...y.. a......c....,r:... ...y......i......i.....:. ' ........ <br /> •• . <br /> ...... ..y....... <br /> .;......:......i..........-...y. ..y......:.......?....... <br /> ......;�.. <br /> .. ..4 ..;... ... .......... •�.�..T.........ir.. <br /> ..p.. ...d... ....... ...{..... .. •••.•.r•ir_ <br /> ..;......•.....' .. <br /> ..?......c......p <br /> ...................:.... :r............i............. <br /> I. <br /> ..p.... i i a............a _ <br /> .:.. . .. .. <br /> ..p.. ... ............... .,. ...p... <br /> {, ..y.....�... y......�......q .. <br /> .. <br /> .,j. .. ............................i.. ..i.. .i... ...moi.....'......• . .. <br /> 3......:......y.....�«..................p......:.....r <br /> .-4......�....�....:.....r...........;.... <br /> 4• ..;.... ..y,.... <br /> .;..........�.5......�...................................3......:.,.... .. <br /> - ..:......;.............y.............i.... ...L...... 4..... p............} <br /> : . .j......:. ...i..............i..• <br /> I . ; _ ...,}...._•....•.;......•.......9......�............. <br /> ...:......p......�......J.............y... }...... .y......:.. <br /> :...«. ......:......;.............i... ........i.............' <br /> :... <br /> .f <br /> : <br /> .....:....... <br /> ..j.............p....-:.......q......�....i,.......:......y......:. .. <br /> .. ...j....... ...j......'. .y... ..p.......^....j.............;,.. .. .. <br /> ..�... ..?.. n c... ..;.... .......:.....: 111111 ..;......:......,,. ...y...... <br /> ..;... .. .......... <br /> ..4......:......3...... ...5......:......;...^_,......;.... ..i.............�.. <br /> ..;. .._{.... •'• .y......•............:......y...... <br /> ..;.. ..b.. ...r'.....%.......:......;......:..... <br /> .;......'.... , ...Q,......�.............•.......... <br /> .................... <br /> ....... <br /> ...:......,i......:............:......;..................... ;......i.... .. <br /> ..............s.............i. <br /> ........... A <br /> ..d............y......:......5......:......;......:......i........... <br /> ..t......?......i,......i......i....... ...•i......:....:........:......b......i......a...... ..a......�.....:6.....:.......'..�r4"`:1 \`71•'P7' c •...:... .. <br /> ....... ..i............. - fil.......: . <br /> .i.. ...... ...p.. ..;« .. y...... <br /> ..;.. ..5.. ..,j..^^:......;.. ..j.....•......•. Ij�✓,P + <br /> "1 <br /> 1/ <br /> •tit�' <br /> ' :.f.r. <br /> .:J <br /> 1. <br /> ri• <br /> -v. <br /> .•:may`.. .. <br />