SU0002167 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERMIT S"JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON, CA 95202 (209)468-3420 FILE COPY JUX-REFUNDABIR PEIMI XPIRE8 t YEAR FROM RATE ISSUED ICBfaphL6 ID Trlpl isj APPLICATION 18 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANOIOR INSTALL THE WORK DESCRIBED. THIS APPLICATION!S MADE IN COMPLIANCE WITH BAN JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DM81ON, JOB ADDREBB/OR APNN � OWNER'S NAME _i 7^ `, i Yl ADDRE88 Lor BIzF��[i CONTRACTGw ADDRESS PHONE��a9--t/i-73 E2414 aLIC, PHOFIE �� 3 T� Ill BUB CONTRACTOR ADORE88 + LICI PHONE 4 TYPE OF SEPTIC WORK; NEW INSTALLATION REPAIR/ADDITION ❑ OUTRUCTION❑ IND SEPTIC SYSTEM PERMITTED S PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BURbINO.I YERC TSST10 I 1 NOW MANY Y C_ /�/ APPBarden IkSTALLATIOk WILL SERVE: RESIDENCE❑ COMMERCIAL� OTHER©OjfI,L.'�- � NUMRER OF LIVING UNITS: - NIISAB9L OF BEDROOMS: - mQ �.�/`IC!/i�,TJX-Q..4_ N-10 D (C AC ER OF 501E TO A DEPTH Of FEET - pIT11 MUMP BOIL.CHAgACTER.- WATER TABLE DEPT �.:J EFTIC T X/OREABE TRAP ❑TYPFlMF If2'y�`jF 'CAPACITY -QO I NO.COMPARTMENTS 0-1 TREATMENT PUNS❑ DISTANCETO NEARE6T: WELL FGUHDATroN:Sa , 1 PROPERTY LINE LIFT STATION❑ SIZE TYPE OF PUMPSAND OIL SEPARATOR IENCLOSED 9YSTEMI" p + 4} LEACHING LINE 00 NO.a LENGTH OF LINES '�Ic7ch /LC S DISTANCE TO NEAR£STr WELL FOUNDATION/6D PROPERTV LINE /o_Z s ' FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEARESTI WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH 018TANCE TO NEARESTt W/ELL'} FOUNDLINEATION PROPERTY LINE SEEPAGE PITS ©DEPTH SIZE NUMBER DISTANCE TO NEAREarri yyELLf . _. FOUNDATION PROPERTY HE BUMPS ©WIDTH LENGTHDEPTH DISTANCE TO NEAREStt WELL FOUNDATION .PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCETO NEAREST:WELL FOUNDATION PROPERTY LINE 1 I HEREBY CERTIFY THAT f HAVE PREP ED THIS APPLICATION AND TH WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RALES AND REGULATIONS OF THE SAN JOA IN COUNTY."a OR EN AGENT'BMiNATURECERTIFIES THE FOLLOWING-•{CERTIFyTHATINTHEpfRFORMANCEOFTHEyygRl(FpgyyHlCH THIS PIE ISsuED,1 NOT PLOY ANY PERSON IN SUCH MAN ER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HNNO OR C BUB C NTitACT elONAT CE FOLLOWING: CERTI E OF THE*bW FOR WHICH THIS PERMIT 18 ISSUED,1 SHALL EMPLGY PERSONS SUBJECT TO WORK AN'B CO TfO INS ALI RMA.• THE T MUS CALL 24 HOURS IN ADVANCB FOR ALL INSPECTIONS. COMPLETE DRAWINO BELOW. SIGNED ` ? _ TITLE: PLOT PLAN MMW TO SCALE}SCALE •le 1. NAMES OF STHEETB OR ROADS H DIMEN IO OR AND O1N0 THE PROPERTY, 4, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2, DuTLmEIMENSI OF THE PROPERTY.WITH DIMEN810N8 ANO NORTH DIRECTION, EXPANSION OF SEWAGE DIBPOBAL SY6TEM8. 7. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES. 6, LOCATION OF WELLS WIrMN RADIUS OF ONE HUNDRED FIFTY FT.OH INCLUDING COVERED AREAS SUCH AB PATIOS,DPoVEWAYB,AND WALKS. w., h ..: .. `I u .. .... -.: : :::::::: ::. Aug - B.1998:: .. ... fry�'utl .... S Wl puNE } M.I.Y. .. .. AU � NTA ��L IVt ON .. . h" .....:......:... .. .. . . ........:...... ... ..... .................... ...........::. .......... . .. mac' �. 'D ...... FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY DATE: AREA: z- TANK,PIT OR SUMP INSPECTION By ATE_- I �FINAL INSPECTION 8Y ATE1�] ADDITIONAL COMMENTSkL Wd N ACCOUNTING ONLY: ATOP FACS 9£CODE FEE INTO AMOUNT REM ITED CIISCKf A8H RECEIVED BY DATE OR I PMAT NUMBER INVOICE t Pub.HeaRh Serv.-ETlvlro,174(3196)