SU0000752 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERMIT -A JOAOUIN COUNTY PUBLIC HEALTH SERVICL ENVIRONMENTAL HEALTH DIVISION P.O. BOX 38B, 446 N. SAN JOAOUIN ST., STOCKTON, CA 96201-0388 (209) 4683420 NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT Triplicate)in AND/OR INSTALL THE WOW(DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE MTN SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESS/OR APN# 7,�/C%J .� /yJ �� - �•G- r3-2i7<. T' CITY' !- LOT SIZE A`4> OWNER'S NAME /1 U >•�/ ADDRESS ZZl,1fC; ,['- ,r9 ��..� L /�_. PHONE S Y.7-3e - L.• CONTRACTOR 0 i:��._/fJc!•�p"✓�- /tom=4f� RUC! PHONE S3 w�- jZ fZ,I SUB CONTRACTOR ADDRESS UC! PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PEO TESTW 1 1 HOW MANY .3 C S-1-/ 54,,A ,:l r r-sry�/,> �<.• -3 /,/> < Syji">T ' irr/9 ) APPEu.6on./JI S INSTALLATION WUJL NCE CR R 11 NUMBER F LIVING NIITTS: RESIOENU BE OF BEDROOMS` ❑ OTHENLANBEI OF EdROTEFi: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANKIOHFASE TRAP ❑TYPEWFG CAPACITY NO.COMPARTMENTS MIS TREATMENT RANT ❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENC OS 8Y 1 LEACHING UNE ❑ NO.&LENGTH OF LINES NE LL FOUNDATION PROPERTY UNE FILTER BED ❑WIDTH LENGTH DEPTH 1 TA REST: LL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH DEPTH T EAREST: LL FOUNDATION PROPERTY UNE SEEPAGE RTS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELLFOUNDATION PROPERTYLINE SUMPS 11WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WEIR FOUNDATION PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH_ DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATON AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN"AMIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. SIGNED TITLE: G�^"rri�/ f� p awl DATE: 101IZ19� YYY 'Ie OT PLAN(DRAW TO SCALE)SCALE •m 1. NAMES OF STREETS OP ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 2. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERLY. 220 r-r5ra J r Jo, / Ttst M A3 8 C O optNJ 1[ J PAYMENT /So ➢os" zqs - RC EIVFIJ OCT 1 2 1994 _ — — SAN JOAQUIN 1;OUW Y PUBLIC HEALTH SERVI((LS ENVIROoAJMEPJTAL HEAI.J}I,91V1;;i )I'I FOR DEPARTMENT USE ONLY APPICATION ACCEPTED BY --� DATE: '"� AREA: - [AHK.PL OR SUMP INSPECTION BY DATE / / FINAL INSPECTION BY C DATE ! / •'/ ADDITIONAL COMMENTS: ACCOUNTING ONLY: AID! FAC# PE CODE FEEINFO I AMOUNTREMITTEDECK /CASH RECEIVED BY DATE SR/PERMIT NUMBER INVOICE! r,2 �� 3 lo-1 0 LA q 0Q U l