Laserfiche WebLink
APPLICATION FOR LIQUID WASTE PERF <br /> I JOAQUIN COUNTY PUBLIC HEAcrH iVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED <br /> — — ICeIDPIBtB M TisIiRBtBI <br /> AMICATION IB"STORY MADE TO THE RAN JOAA�EOEgUIN COUNTY FOR A PERMIT TO CONSTRUCT ANOAID INSTALL THE MURK DESCRIBE". TIRE AMJCATION IN MADE IN COMAIANCE WITH BAN <br /> J�fl WD"RERS Dn AM11 N COUNTY 0 EVELO/ TA C �Ff_+A E ��10.3 AND�IE STAN 8 c VNTV N CIry7EALTH SEA CEO HIRED,ERAEMAL NFAITN DIVISION,OF RIlF <br /> O.FR'8 NAME lY•Yp /AnnnERR `/ f/ V�Jy L^, AgNE //!! <br /> CONTRACTOR A[gliFfiF lK'I F t ' �ANJNE `/ <br /> RUR CONTRACTOR AIRIM.9 LIQ, PHONE <br /> TYOE Of SFT'TIC WORK: NEW INSTALLATION RFFNNAOdl10M ❑ 1R TOM❑ <br /> MO SEPTIC SYSTEM R 21 <br /> DMITTED IF AIRLIC wMVER IS AVAILABLE WITHIN 0 TFFT DE 811111NN 1(f�11 D P91C TF/TNI 1 1 NOW MANY <br /> 1 / AvMlentlnn I <br /> INSTALLATION MIT.SERVE RESIDENCE❑ COMMERCIAL ❑ OTHER❑1 Lf <br /> I ��ll <br /> NUMBER OF"NO UFXTR: NUMBER OF BEDROOMS NUMRFR OF MMOYM. /� I <br /> CHARACTER OF SOIL TO A MMII OF O FEET: MMVMP SOIL CHARACTER:� ,� WATER TABLE DIRMH lZfl <br /> BATC TANKXIIFAEE TIME ❑TYR/MFi' (I' TE"' F'L CAFACPTY ��..t ////E/ NO.COMPARTMFNTP <br /> ' —s <br /> PRO TRIMMEST"PITEI DISTANCE TO MFMFAT: WELL FOUNDATION FTIOPERTY LINE <br /> LIST STATION❑ RIZF TYPE Of NMP_SAND OIL REPAMTOD RNC"IOREO SYSTEMf / <br /> LEACHINGLINE NO.R LFNOTII OF LINER C1 �V O • DISTANCE TO NEARFRTI WELL FOUNOAT--__:: RgRRTY UNE <br /> ALTER RED ❑WNTTH LENOTH 111 DEFTH DISTANCE TO HEARERS WELL FOUNDATION RgRRTY TIME <br /> MOUNDED ❑MOTH LENGTH DEFT" DISTANCE TO NEARf BT!WELL FOUNDATION ritcitvT UNE <br /> / _ <br /> BFEEAOE NT ❑DFF81 <br /> TH 2E (n () NUMBER <br /> E DISTANCE TO NEARFRT�WELL FOVNDATgN PIgRT'IlINE16_ <br /> `SUMPS ❑MOTH LENGTH DFFTH DISTANCE TO NEAREST!WELL FOUNDATION PEIORRTY LINE <br /> d/POBAL PONDS ❑MOTH LENOTII DEFTII DISTANCE TO NEAREFT:WELLFOUNDATION IOORRTY IME <br /> I IIFRERY CERTIFY THAT I HAVE TTFPARfD THIS AMICATION AND THAT THE WDW WILL RE DONE IN ACCORDANCE WIT"SAN"AMIN COUNTY OR INANCER AND STATE LAWN,AND RULER <br /> AND REGULATIONS OF THE RAN JOAOLIIN COUNTY.HOME OWNER OR ICENMO AOENT'/MONATLNE CERTIFIES THE FOLLOWINO:'I CERTIFY THAT IN THE PERFORMANCE OF 114EMM FORWHICH <br /> RICH <br /> TIER PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AN TO BECOME SUBJECT TO WOR(MAN'9 COMPENSATION LAWS OF CALISOIIMA,- CONTRACTOR'S"PRN"OR <br /> RUR CONTMCTINO SIONAT VR CERTIFIES THE FOLLOWING:9 CERTRY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH TIIIB FFSMIT IS ISSUED.I MM L FMA OY MRSOHR SUBJECT TO <br /> Y MMAN'R COMRNSATg"tA..W�/S]�Of�C/A�L/XO�MIA.- THE APNCANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REUMM INSPECTIONS. COMFIFTE d111W1N0 BELOW. <br /> RHONE"X �Al 1 1 r F 1 /FJL-Yl/lT� TITLE: DATE!- <br /> MOT AOT IRAN RRU1W TO SCALEI SCALE_ 'In f\ <br /> 1. NAMES Of STREETS OR ROADS NEAREST TO OR BOUNNNO THE RbRRTY. A. LOCATION OF HOUSE SEWAGE dMONAL SYSTEM OR PIgFORED G <br /> 2 01"LINE OF THE ASIRRTY.MAH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF NEYJA(E dRIOBAL SYSTEMS. <br /> 3, DIMFNSIONFO OUTLINES AND LOCATION OF ALL EXISTING AND PROMBED STRUCTURES, S. LOCATION OF WELLS WITHIN FACRV/OF ONE HUNOM..O FIFTY R.ON <br /> INCLUNNO COVERED AREAS SUCH AS FAME.t11BVEWAYS.AND WALKS. -- THE PROPERTY OR ADJOINMO PTIOPERTY. <br /> W 4n d <br /> pm'z <br /> �0 S, <br /> 1� <br /> NVIPnI,!IA, 1 AI J' T 1"TNih. :�. / <br /> � //(��(�� <br /> 1l1y1t1/11 �F�OTR�D�fPAPTAIFMT USE ONLY <br /> AMICATION ACCfITFD BY�Lj'����J' Ct <' W—Y ASA\. DATE L j I AREA: YI <br /> D <br /> TAINT.AT OD RUMP INNRCTpI!BY DATE I FINAL INRRCTION B "ATF <br /> ADdT10NAl COMMEM9y\ I',��� p L1 G 1,_yVF• c� L' V I`VE ` µ 11 �-[ �(. y <br /> 11 \ Q V_I�C.I G {'L•.- '�t��` 1 �CJ 1�`3�6- C - J'7��H <br /> COO P ATI lie CLOoh E.e <br /> ACCOUNANO ONLY: AIDE FAC, L_L . =88 T 6// -} <br /> PER IMO AMOUNTMIN"ITED CFIECR/A:ASII REC BY DAE MIP@pBT MISABEI INVOICEFStiI Ig 51 LT <br /> l <br /> PUh.HeaBh SRN,-ERIIO. 174(3/95) <br />