Laserfiche WebLink
�11 <br /> L APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,445 N.SAN JOAQUIN ST., STOCKTON,CA 952010388 <br /> 12091 4683420 <br /> NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (temples I.Trylk.tai <br /> Application is hereby made to the San Joaquin County for a permit to construct and/or install the work described. This application <br /> is cede in compliance with San Joaquin County DeveLopmnt Title, Chapter 9-1110.1 and the Standards of SanJoaquf�ty Public Health <br /> Services, Environmental Wealth Division. (Do <br /> o I -I su <br /> _ Job Address/or/A�APPNN f/�// ./ ��in,ri� Pte. City _ Let Size 5 ✓ic <br /> Dicer's Xame dit/k4-d A.LK�{.J / Address 5hi / ,,/ Phone % <br /> Contractor 6--o Zw4L YEYfrr,e �cAddress ��� h4 ;?4(-- Die- Lic# Y2r/5- Phone--g%rdZ7 <br /> r � <br /> sub Contractor Address Lic# Phone <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION II REPAINADDITION bt DESTRUCTION II PERC TESTW II Have nemF <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) <br /> Lead Use AMOmetim N <br /> a. Installation will serve: Residence Commercial— Other_ <br /> Number of living unitar_t_ s <br /> Number of bedromnOj Number of mryleyase:_ <br /> Che ay�ter of soil to • depth of 1 fast: dny Pit/Sump Sall Chanctan�_Water Tobt.Depth <br /> IC TANIUOREME TRAP D Type/Mfp Capacity No. Cmportwnte <br /> PKU TREATMENT PLANT I ] Distance to nearest: Wall faWetion Property line <br /> �.I LIFT STATION[] Size_ Type of Pump_ Sand OIL Separator (enclosed system) <br /> LEACHING LIKE R No. U length of lines-Lip r Distance to Nearest: Wait )%b Fodxd tien-9-0L Property Limes 4- <br /> a- <br /> - <br /> ` FILTER BED lT Width_Length_Depth_ " a Well_ Foundation_Property Lira <br /> MOUNDED (] Width_Langth_Depth_ " " Well Foudatior Property Link_ <br /> SE®ASF PRR Depth Size 'W' NunherJ_ • • Yell 175 r Foudatian��b• Property Liro <br /> sows 11 Width_ Length_Depth_ " " Yell_ Fondation_Property Line <br /> DISPOSAL PONDS IT Width_ Length_Depth_ e " Well_ Foundation_Property Link_ <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances <br /> W State Laws, and Rules and Regu Latioro of the San Joaquin County. Woes owner or Licensed agent's signature certifies the faLLowing <br /> HI certify that in the performance of the work for which this permit is issued, I shall net employ any person in such a manner as <br /> �. to became object to workmen's cmWensatfon lawn of Califomia.H Contractor's hiring or sub-contractiro signature certifies the <br /> following: muni certify that in the performance of the work for which this permit is issued, I shaLL mmpLoy persons subject to workman's <br /> compensation Laws of California." <br /> The appRraet next saR 24 bourn In adeaexs for all reNdrad bw,edem. Complete drawing below. <br /> ... Signed X Wk&��a Title: Date:,,! <br /> PLOT PLAN (Draw to Scale) Scale H to <br /> 1. Names of streets or roads nearest to or bonding the property. 4. Location of house sewage disposal system or <br /> 2. outline ofthe property, with dimensi ane and North direction. proposed expansion of sewage disposal systems. <br /> 3. Dimensioned outlines and location of all existing and proposed 5. Location of ce LLs within radius of 150 ft. on <br /> structures, ins I Wind covered areas such as patios, driveways, the property or adjoining property. <br /> and walks. <br /> LL Y <br /> o <br /> 1-95Aw*- <br /> U'P'1IlUEN1_USE ONLY <br /> Apptice on Accepted by ` '` " yY oat.. Feo /Area• S <br /> Tank, rat or Sump Ins //e� [nal Inspection by Data <br /> Additional CgmRnIB: 4 <br /> WeN <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODE I FEE IMfO AMOUNT REMITTED CNECKryCASN RECEIV 0 BY DATE SR I PERMIT NUMBER INVOICE N <br /> t <br />