SU0007221 SSCRPT - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 445 N. SAN JOAQUIN ST., STOCKTON, CA 952010388 (209) 4683420 NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANO/OR INSTALL THE WOW DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAGUIN COUNTY DEVELOPMENT TITLE,CHAPTER S- 110.3 AND THE�STANDAR�D/S OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,EIJVIRDNMENTAL HEALTH DIVISION. JOB ADDRESSNR APNf ^` - '--C/l�'C /ll T. / clry � �-%! 7-,-'/ ]Lor OWNER'S NA C/ 42>1t1 AOOIIE88 PRONE -, C/'- JC' �-ONTRAC ADDRESS k' � IJCP�L b Z PHONE SUB CONTRACTOR ADORES& LJCI PHONE TYPE OF SEPTIC WORK: HEW INSTALLATION ❑ : ADDITION DEBTIIUCTIDN ❑ NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF SUILDING.1 PE RC TESTM I 1 HOW MANY Appbosuon# INSTALLATION WILL SEINE: RESIDENCE'4. COMMERCIAL 13OTHER 13 NUMBER OF"NO UMTa:�— NLMIB61 BEDROOMS'. '� NUM661 OF EMMOVEEb: 77 CHARACTER OF SOIL TO A DEPTH OF 3 FEET // ;, PT/SUMP SOIL CHARACTER: WATER TABLE DEPrH zdC f J SEPTIC TANK/ORREASE TRAP ❑TYPE/MM CAPACITY NO.COMPARTMENTS PKO TREATMENT PLANT El DISTANCE TO NEAREST: WELLFOUNDATION PROPERTY LINE \I UFT STATION❑�� l-SIIIIIZ��/�E TYPE OF PUMP_[[T SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACNNO UNE .IS LENGTH OF LINES �ju DISTANCE TO NEAREST:WELL rO FOUNDATMN�PROPERTY LINE \ FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE MOUNDED 13 MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE PITS DEPTH SIZE - /I NUMBER DISTANCE TO NEAREST:WELL'J(�C,' FOUNDATION_1�PROPERTY UNE SUMPS 13 MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE -" DISPOSAL PONDS 11 MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE Z I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WON(WILL BE DONE IN ACCORDANCE WITH SAN fOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES -�j- AND REGULATIONS DEERE SAN JOAQUIN COUNTY.HOME OWNEROR LICENSED AGENT'S SIGNATURE CERTIFIESTHE FOLLOWING:'I CERTIFYTHAT INTHE PERFORMANCEOFTHEMW FOAWHICH THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE MW FOR MICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO NOWMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. L�SIGNED X TITLE: DATE: PLOT PAN(DRAW TO SCALER SCALE 'to 1. NAMES OF STREETS OR 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. 1. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. PAYME RECEIVED DEC 8 1994 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVMNMLNTAIJI.` -TH U1N:J . _1.