SU0010364 - Laserfiche WebLink

Home Browse Search

` APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 n 15 (209)468-34201_ NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATjjgSUEO ( �� ICmnrkte In TrbOnal l0 APPLICATION 11 HEREBY MADE TO THE BAN JOAGUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOW OESC WEED.THIS APPLICATION 18 MADE N COMFUMY E WITH BAN f JOAQUIN COLN.Y OEWLoPM/EJNF ET/TLE,CHAPTER 8-(11111J0.3��AND THE STAMOmm OF SAN JOAOU1N COUNTY PUBLIC HEALTH StMACES. MVIRONMfNTAL HEALTH DIN/JMNI--- JOB -- JOB ADORESBIOR A-NO L'`(0DO I LVY�YJ /�� CT/ J f—0 /� (lrOT BIZE�j Ir OWNER-8 NAME SLE.S6II-� T(-i`(I-Of<//wL A-eCC- AOOFESB o2 'j A 4 c (vf� N+-G,111 <31OLK+U'1,L�� NE_-1 tf 3- /7�F 3 CONTRACTOR 'E W 12 4L VA 1„L V ADDRESS a C I-a 7 o ' LFc•Jr W 4 3 PFNANE fj 3--) 6 SUI CONTRACTOR AODRE68 415 0 LIC• PNONE TYPE OF SET'TIC WORK: NEW NSTAUJLTION❑ ASv.wADD1TION ❑ bpTwUC ilO NO SEPTIC SYSTEM FUWtETED IF PUBIC SEWER IN AVAILABLE WITHIN 200 FEET OF BUILDING.) P91C T11TN1 1 I YAW RABBET MPlwrE6 I_ INSTALLATION WILL NERVE: RESIOENCI-❑ COMMERCIAL❑ OTHER❑ NIMNER OP IFNNO LRMTS: NU MMUR OF BEDROOMS: AILDMI 1 OF PVI.OYHI: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: FTTISUMP BOIL CHARACTER: WATER TABLE OMIT SOTIC TANRgRA/E TRAP ❑rasmv) CAPACITY NO.COMPARTMENTS FRO TREATMENT FLINT❑ WSTANCE TO NEARLIT: WELL FOUNDAHON FlOPLRTY UNE UFT STATION Cl SIZE TYPE VF PUMP BAND OIL SEPARATOR(ENCLD6ED BYSTEMI _ WCNNO UNE ❑ NO.B LENGTH OF UNES_ DISTANCE TO NEAREST:WELLFOUWATR)N PRORERTY UNE FILTEN SED ❑WIDTH LENGTH DEPTN DteTANCE TO NEAREST:WEU FOIFADATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH—DFPTH DISTANCE TO NEAREST:TALL RANDATION PROPERTY LINE SEWAOE MS ❑OEPTH SUE _NUMBER 0497 H E TO WAREST:WELL _FOUNDATION PROPERTY UNE SIMM ❑WIDTH LENWM _DMH DISTANCE TO NEAREST:WFTL _FOUNDATION PROPERTY UNE DlSPOSK PONDS ❑WIOTN LENGTH DWTH DISTANCE TO NEWEST:WELD_FOUNDATION PIOPM"to* 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WON(WILL RE DONE N ACCORDANCE WITH SAN JOAOINN COUNTY ONdNANCES AND SFA-TE LAWS.AND PULES AFD REOULATONo OF THE BAN JOADUIN COUNTY.HOME OWNER OR LIC ELTBED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:T CEATIFYTHAT LATHE KFFOIWANCI OF THE WOW FOR WHICH TWO PEHWT IS No 1 SKALL NOT EMPLOY ANY PERSON N SUCH A MM INER AN TO SEC OME SVWECT TO WOIKMMYB COMPENSATION LAWS OF CAII'OISSA.` CONTRACTOR'S"&111IIG OF SUB-CONTRACTINO BHYIATUIR CETROES THE FOLLOWNG:'1 CERTIFY THAT N THE FERFOR AANCE OF THE WORK FVR WHICH THIS PEUWIT W ISSUED.I SHALL EMPLOY PEFbONS SUBJECT TO WORKMAN'S COMPENSATION LAWS SOF•CAoLIF/JO�RNIA.- THE APPMRNT MUST CALL 24 HOURS IN ADVA/ICS FOIL NY REOUIRED NSPECW"S. COANiETE DRAWINGG{B-b4v. CL�-i /, , TITLE. \ DATE: SIGNED%y� / - POT RAN DRAW TO SCALE)SCALE_.-' 7. Oi SITEETB OR RDAOS NEAlEffT TO Oft BOUNDING TRE PROPERTY. Ia4.LOCATOST N OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED NAMES 2.OURINE OF THE PROPERTY.WITH DIMENSIONS ANO NORTH DWCTON. FLO A T ON OF SEWAGE THINRADISPOSAL SS OF O S, 3 DIMENSIONED OUTLINES AND LOCATION OF ALL E%ISTNO AND PROF06ED STWUCTURT6, S.LOCATION OF WELLS WITHIN RAMS OF ONE HUNDRED FIFO"!FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,Of7VEWAY8,AND WAITS. THE PROPERTY OR AO.ANSIO{11DP[IRY. TC `J : -: : ... .. ....... r1 ST` PF► VED I ��; ,� b }lid .:' FEB \ � � SAN .HP.ALTH SERVICES 14-C AM PUBlJCt1�LFM-SERVICE& ...... .......:... ENVIRONMENiAI HEALTH DrOWt ..... -..�� i A E➢MTMEN7 USE ONLY t L� DATE: -�-1--� APPUCATION PANIC.PLT OR SUMP Ne'4CTRR1 BY kj-- DATE7 j;4/jC:l) FINAL INSPECTION BY II OA7E J ADDITIONAL COMMENTS:91�R-ol SRT! Lam^Y!Mf TNT. tPwM 7,laCI A.1 kt( � lXa'7Ro ytO lonT uliV P.Riliu q•9.z�ERn+LT " oot,; 4r 4 Y o2 v 5. Sr►Av r 55 Lvle�(`GU — SAJ ACCOUNR.G ONLY: Luo/ FAC• ""-- / - '�, PL CCOE FEEIN' AMOUNT A13WITED CIIEC JCASH RIC BY DATE •G JRgIT NLMSER INVOICES C) L� Sb3 Pub.Health SON -EOVim 174(3196)