Laserfiche WebLink
F ' APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 389, 445 N. SAN JOAQUIN ST., STOCKTON, CA 95201.0388 ,�. c) <br /> F (209) 468.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> ri APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN } <br /> JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.3 AND,THE STANDDARDS O SAN JJO�-A{/Q-UIN COUNTY PUBC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDRESSOR APN# /_.J_.f 7l � ��] 39 44 A� CITY L--e&L � ACA-J-7F OWNER'S LOT S/IJZE� <br /> OWNER'S NAME Ahe �7 5,4 ADDRESS .atm+'��'C _ PHONE <br /> CONTRACTOR1'r7, ADDRESS , ..I �('Li/�'Y/I!I f � .LIG► C l PHONE 1 <br /> Y 1 <br /> I SUBCONTRACTOR ADDRESS LIC# PHONE k <br /> 33 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRIADDI ON DESTRUCTION ❑ F <br /> 4 <br /> INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING) PERC TEST[01[ I HOW MANY <br /> AppLioatlan# <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER❑ LL` <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CH SOIL TO A DEPTH OF 3 FEET: 6�G A, PfTISUMP SOIL CHARACTER. -A-6-� ZL-&cJ ATER TABLE DEPTH 1 <br /> SEPTIC TAN EASE TRAP ❑TYPErMFG�Z+'�"� CAPACITY„r+..cw W4100 �/ NO.COMPARTMENTS ' <br /> F ENT PLANT❑ DISTANCE TO NEAREST. WEIJL, ' s,-- FOUNDATION 6�V t- PROPERTY LINE 16 f- <br /> LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR 4£NCLOSEO SYSTEM) <br /> LEACHING UNE NO.6 LENGTH OF LINES IDt�'Y 25 f�;W 4ro DISTANCE TO NEAREST:WELL,!L�FOUNDATION­5�2�PROPERTY LINE <br /> FILTER BED ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE _ (t <br /> SEEPAGE PITS �DEPTHE <br /> _SIZ _NUMBER / 4-_DISTANCE TO NEAREST:WELL .�Z:p FOUNDATIONy��PROPERTY UNE (L i <br /> _.J._- --. <br /> 6UMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE e <br /> F DISPOSAL PONDS 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> FI 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 r <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.ROMEO EER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FORWHICH ? <br /> THIS PERMIT IS SUED,I .L OT't!NI EY ANY PERSON I UCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.• CONTRACTOR'S HIRING OR <br /> SUB-CONT TING CE IES E FOLLOWING: I FFY 7HATlN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 155U1ro,I SHALLEMPLOY PERSONS SUBJECT TO <br /> WOPoLM 'S C774S�Ai ����T CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED <br /> 'INSPECTIONS. COMPLETE DRAWING BELOW. !� <br /> SIGN X TITLE: �C -Y iL-H- DATE: <br /> n <br /> PLOT PLAN(DRAW TO SCALE)SCALE "to <br /> 1. NAMES OF STREETS OR NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED ! <br /> 8. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3, DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND YIf�I. .� ��( THE PROPERTY OR ADJOINING PROPERTY. <br /> .. <br /> ......................... . .. <br /> L. 4 ... ... . F,/au <br /> ., . ., <br /> " <br /> lL <br /> Ito <br /> ......................... ........ .... <br /> .. ......................... ............... . <br /> I`�lc T s ....................... <br /> -16 -r•.t� r�.i, I�n,L���t <br /> 6-iqAf <br /> ........ .. . ... . <br /> Yr'` ..,.............. g b <br /> .. <br /> ................ ...... ........ <br /> ............ <br /> ..................... <br /> . ..... .............. <br /> ............... ......................... .......=.Q <br /> .. `. ,. 4 <br /> 'c c <br /> ............. ....... ............. <br /> .......... <br /> a......................... ......... ............... ...... <br /> n. <br /> ...................... ...... <br /> ............................. .................................... .... . .......... .............. ..................... ....................... <br /> ............ <br /> ................ ....... <br /> y! q�p <br /> �� .z � C.�rG14� s l�3��' <br /> :: <br />