Laserfiche WebLink
■°e APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> r• P.O. BOX 368, 446 N. SARI JOAQUIN ST., STOCKTON, CA 96201.0388 <br /> (209) 468-3420 <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> law Application is hereby made to the San Joaquin County for a permit to construct and/or install the work described. This application <br /> is made in compliance with San Joaquin County Development Title, Chapter 9-1110.3 and the Standards of San Joaquin County public Health <br /> Services, Environmental Health Division, <br /> ` Job Address/or APN# /C',�L «�/ � C i t - <br /> '" Y � Lot Size �-e> - <br /> wner's Name Address c s' c � ' <br /> 9 _� %% 4° / Z�f�ci;11�-''' Phone3lii��53�5.. <br /> Contractoq - 1i 14; ; .�r� /"1 I'nV Address �¢/��lr��7 ��1✓�� J S Zz// Lic# j;eg LLi� Phone--Z'5/ C:5 <br /> Sub Contractor Address Lic# Phone <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIRIADDITION 1 1 DESTRUCTION I I PERS: TESTW I I How man; <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) <br /> land Use Appliestiaa # <br /> Installation will serve: Residence_ Commercial Other <br /> Number of living units:--L— Number of bedrooms: Number of employees:_ <br /> Character of soil to a depth of 3 feet: - 1 4(,.t ,PIt/Sump Soil Character: f Water Tsble Depth `ir4 l- <br /> SEPTIC TANKIOREASE TRAP X Type/Mfg n "rr }' r , e,' r <br /> -� .C�z �%l _ -nc / Cepaclty %� No. Compartments- e <br /> i <br /> PKG TREATA?ENT PLANT [ ] Distance to nearest: Well IEC. I h Foundation / Property !Inc I EC'` , <br /> LIFT STATIONL] Size Type of' Pump ._ Sand Oil Separator (enclosed system) <br /> TEACHING LINE No. S length of lines33 -&/"t/",- Distance to Nearest: Welles Foundation.�k5'r Property LinPICF'` t- <br /> FILTER BED U Width Length Depth " " Well Foundation Property Line <br /> ABOUNDED 0 Width Length Depth " '° Well Foundation Property Line <br /> SEEPAGE PITS 0 Depth-, F. Size y z „ Number 7 " " Well &C'm r Foundation 7� Property Line %« <br /> SUMPS ❑ Width Length Depth " " Well Foundation Property Line_ <br /> DISPOSAL PONDS 0 Width Length Depth '° " Well Foundation Property Line <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances <br /> and State Laws, and Rules and Regulations of the San Joaquin County. Horne owner or licensed agent's signature certifies the following <br /> "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such a mmanner as <br /> to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the <br /> following: i1I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's <br /> compensation laws of California." <br /> w. The applicant must call 24 hours in adv a for all required Inspection#. Complete drawing below. <br /> Signed X � —� �= Title: �l: I Date: 0d <br /> PLOT PLAN (Drew to Scale) Scale " to <br /> 1. Names of streets or roads nearest to or bounding the property. 4. Location of hougt A bftz'Id; b$ i system or <br /> 4 II <br /> 2. Outline of the property, with dimensions and North direction. proposed expansion o sewbge_t���d" posal systems. <br /> 3. Dimensioned outlines and location of all existing and proposed 5. Location of wet 10 thin rQW, of 150 ft, on <br /> structures, including covered areas such as patios, driveways, the property or"adjoin_ing property. <br /> and walks. <br /> PT—7, <br /> _1 <br /> T:7F <br /> I <br /> J� I <br /> r <br />