Laserfiche WebLink
�vPLICATION FOR LIQUID WASTE PERMIT _ <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE, STOCKTON, CA 95202 �� ^ <br /> (209) 468-3420 <br /> NON-REFUNDABLE PERMIT E%P1RE5 I YEAR FROM GATE ISSUER IL <br /> (W.piaiB In Lipl-Nabl <br /> HE <br /> APPLICATION <br /> HEREBY <br /> EVE OP�DE TO THE SAN MENT TITLE.CHAAPTEH SAN <br /> R9-111�DAND HE STNDARDS OF SAN JOAOUINT TO CONSTRUCT ANDGA ICOUNTY TPUBLWIC HfAI MBERNCEB.IENVIRONMEHTAL HEALTH dNeIONS APPLICATION 18 MADE IN ^ EE2� <br /> �l /��,A� ff LOT SIZE <br /> G'A 111 L.1 -^4, crry <br /> JOB AODRESSIOR APNF ILL C.� PHONE <br /> Q � 4r' ADDRESS c 1 3�-777 <br /> OWHER'8 NAME «I�11 UCE [y+TZ 5 rl R10NE�-� <br /> F L<JTO r) 'Q"2s G , <br /> ADDRESS <br /> CONTRACTOR UCE RIONF <br /> ADDRESS <br /> SUB CONTRACTOR <br /> pDSTRUCTON <br /> NEW IU <br /> NBTALTOM REPMRIAOpT10N <br /> TTPE OF S TIC WORK: pR1C TF1Tb1 l I HOW MANY <br /> EO IF RIBLIC SEWER IS AVAILABLE WITfHI/N 300 FEET OF BUILDING) <br /> INO SEPTIC SYSTEM PEPMTTT <br /> Apnllcatlon I�- <br /> [J OTHER <br /> INLTALLATION WILL tFRVE: RESIDENCE❑ COMMERCIALNUMBS of wnoy EB <br /> NUMBER OF SEOROOMt: WATER TABID DEPTH <br /> NUMBER OF LIVING UMTB:,� PITISUMP SOIL CHAAACTER:- <br /> CHARACTER OF SOIL TO A DEPTH OF O FEET' CAPACITY 9 �b EM6 NO.COMPARTM <br /> / f0 <br /> tEPT1C TANA <br /> KREAEE TRAP W TYFEIM FOUNDATION PROPERTY LINE <br /> PNO TREATMENT"Na❑ DISTANCE TO NEAREST: WELL I - <br /> TYPE OF P1MP BAND OIL SEPARATOR IENCLO6E0 BYeTEMI—a� ` �mpav UNE 1 O <br /> LIFT <br /> STATION❑.-6�R/E DISTANCE TO NEAREST.WELL Sl .�� <br /> IL NO_B LENGTH OF UNE8 61 FOUNOATION PWPERTY UNE <br /> LFACN NO UNE DEbTH pIBTgNCE TO NEAREST:W LL <br /> ❑WIDTH LENGTH FOUNDATgN PROPERTY LINE <br /> RLTOI BED DEPTH_DISTANCE TO NEAREST:WELL �- <br /> ❑WIDTH <br /> LENGTH1 S O"� FOUNDATON20' _PROPERTY UNE L <br /> MOUNDED Z[ 11 NUMBER -STANCE TO NEAJN:BT:WELL <br /> �EPTHa� BiiE EGUNDATION PROPERTY UNE <br /> SEEPAGE PTB DEPTH DISTANCE TO NEAREST:WELL <br /> ❑WIDTM IFNGTH FOUNDATION PROPERTY LINE <br /> DUMPS DEPTH DILLSTANCE TO NEAREST:WE <br /> dBPOIAL PONOS <br /> WIOTH LLNOTN RULES <br /> AMIN <br /> HEREBY CERTIfV THAT I HAVE PREPAPFO TH18 APPLICATION AND THAT THE WGTE(WIIl BE DONE IN ACCORDANCE WRH BAN.I CEIGRE COUNTY ORdNFFFOFM ANO STATE IAWB,AND <br /> I BNALL NOT EMPLOY ANY PERBpN IN SIroH A MANNER AS TO BECOME BUBIECT TO WORKMAN'S COMPENSATION UWB Of CALIFOINIA.' COMIUC NS S MWNT OR <br /> AND EBY CEr N)N8 Of THE SAN JOAW IN COUNTY.HOME OVAIER OR LICENSED AGENT'S WO NATURE CERTIFIES THE FOLLONANO:pCERTIFY THAT IN THE PERfOiMANCE OF THE VIOR(FOR W111C <br /> Mroy <br /> S PERMIT to <br /> THIS PERMT IS ISSUED. <br /> WpPIMAN'B C ING SIGNATURE <br /> ER I FES THE FOLLOW <br /> LL WTHE APPIOANT IN THE <br /> 1 HOLR1'INC ADVANCE FOR ALL REOURED OF THE WIM MED,WHICH IBPE TONS ICOMRETE DRAWING`BELOW�NB SUBJECT TO <br /> IRIB.CoNTRACT <br /> TCN <br /> IS' GVIA —DATE: <br /> TR <br /> SIGNED% Io <br /> PLOT PIAN M1JRAW TO 6CP1E1 SCALE_ <br /> •. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> U(pANWON OF SEWAGE DISPAL SYSTEMS. <br /> FT-ON <br /> 1. NAMES OF STREETS OR ROAOB NEAREST TO OR ROD Np1NG THE PROPERTY. S LOCATION Of WELLS MRTOSHIN RADIUS OF ONE HUNDRED FIFTY <br /> 3. OULLINE Of THE T'ROFEER, WITH DIMENSIONS AND NORTH DIRECTION. OR ADJOINING PIS]PERTY. <br /> ]. DIMENSIONED OUTLINES ANO LOCATION Of ALL EE%ST^YBAµO OµAe D STRUCTURES. <br /> THE PROPERTY <br /> INCLUDING COVERED <br /> AREAS SUCH AS PATroB, vi r . <br /> u ` I,xa�I N <br /> L/177 t <br /> x• I ZS S i� I �5 <br /> Ji <br /> _ I � <br /> C. <br /> 3 rL0 PC5\_7_D " i0l <br /> '.. - _;_111JJAJUiNII:JWre7Y .__ <br />