Laserfiche WebLink
APPLICATION FOR LIOUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTI --RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468.3420 <br /> RON REFUNDABLE PERMIT EXPIRES i YEAR FROM DATE ISSUED <br /> (CRmp14tB In Trlplkltd <br /> APMI ATENN IB HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A HERMIT TO CONRTRUCT ANOIOR INSTALL THE WOW DED RIBED, THIS APRRATNIN IB MADE IN COMPLIANCE MITI SAN <br /> "AWN COUNTY DEV MOPM(EE�N�.�TE TIME.CH 9*' <br /> ANDTHESTANDAPDB OF BRIE_JOA,CKON COUNTY PV HEALTH SE CES. 00,010, ENTAL HEALTH DIVISION. <br /> XOR ADORSSpR AMI / V �� • CITY J,-r7 LOT SIZE_ <br /> OWNERS NAME ADORFSS '^ MONE <br /> ti <br /> CONTRACTOR ADDRESS - UCI R10NE <br /> Sun COMMCTOn ADODESS /ICI PHONE <br /> TYPE OF IFRTIC WORK: NEW INITAlUTIOR Ck REPMRADDITION ❑ D"T"MYTON ❑ <br /> IND SEMIC SYSTEM RRMtTTEO IF PUBLIC SEWER IS AVASABLE WIHfN ZOO FEET OF BUILDIEHIJ RIC TUTISI I 1 HOW MANY <br /> API+aEnw I <br /> wITALunON VALL SANE- RESIDENCE O COMMERCIAL ❑ OTHER <br /> NUMBER OF"NO <br /> TA_ NUMBER <br /> CHARACTER Of SOIL TO A DEPTH OF 3 FEET. OF SEDROOMS: PITIGUMP SOIL CHARACTER'' /O WATER TABLE DEPTH "v l <br /> SEPTIC TANKRAREASE TRAP ❑TYEEJMFO T CMAC/ ,,7 /0 NO.COMPARTMENTS Z <br /> PRO TREATMENT RANT ❑ DISTANCE TO NEMFIT: WELL FOUNDATION PROPERTY UNE <br /> LOFT STAnON❑ MZE TYPE OF PUMPRAE <br /> _�) SAND OIL SEPARATOR ENCLOSED M/CLOSED SYSTEI O J <br /> LEACHING UNE NO.!UNOTII OF Mrs I - l D I pBTANCE i0 NEAREST:WELL EOUNOATpN �HNDIERTY LINE <br /> ALTER SED ❑MDT" LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH_UNOTH� _OEM" DISTANCE TO NEAREST:WELL FOUNDATION rromRTY UNE <br /> FFDAO!AT ❑DEPTN _SIZE �A�NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PPIOfERTV LINE <br /> SUMPS D MDT" LENGTH DEPTH DISTANCE TO NEARERT:WELL FOUNDATION PPIOPERTY UNE <br /> DISPOSAL PONDS ❑TMOTH LENGTH DEPEN DISTANCE TO NEAREST:WELLFOUNDATION PNOPERTY UNE <br /> 1 HERBY CEF TRY THAT 1 HAVE POFEWO THIS APMP ATMN AND THAT TIIE WORK WILL RE DONE IN ACCORDANCE WITH RAN"AMIN COUNTY ORINNANCES AND STATE LAWS.AND RULES <br /> AND ROULATIONO OF THE BAH JOA WIN COUNTY.HOME OWTEER ORIIOENSED AGENT'S BIONATUnF CERTIFIER iHF FOLLOWSNO:'I CERTIFYTNAT M THE RR0IVAANCE OF T IIE WON(FOR W111CI1 <br /> TWO PERMIT IS 19"0,1 SHALL HOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO WOM MAN'S COMrENRATION LAMB Of CALIFORNIA.' CONTRACTOR"R HIRING OR <br /> BUR-CONTRACTING MNATURF CERTIFIES THE MMOMNO.7 CERTIFY THAT N THE RRURIAMF OF THE WORK FOR WHICH T1418 PERMIT IS ISSUED.I SHALL EMPLOY RnBONB SUBJECT TO <br /> MMRMAN'S COMPENSATION <br /> LAMS <br /> OF CAAfL/rtORNM.' THE J(PMHU ANT MUST CALL 14 HOURS IN ADVANC!FOR AM MOUNDED INSPECTONS. COMI ETE OMWINO BELOW. <br /> TILE:�L{-( DATE! <br /> PLOT FLAN MRAW TD SCALE/SCALE_ 'In <br /> 1. NAMER OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPF T . 4. LOCATION OF HOUSE SEWAGE DISPOSAL"STEM 09 PBOMSFD G <br /> 2, OUTLINE OF THE NpRRTY,WITH DIMENSIONS AND NORTH DIRECTION. EAPANSIM OF SEWAGE DISPOSAL SYSTEMS. <br /> 3, DIMENSIONED OURNEB AND LOCATION OF ALL EXISTING AND MQMGED STRUCTURES, S. LOCATION OF WELLS WTTRIN DI <br /> RAUS OF ONE HUMMU FIFTY R.ON <br /> INCLUDING COVERED WAS SUCH AB PATIOB,OP VEWAYS.AND WALKS. THE PROPERTY OR ADJOINING PROMPTY, <br /> 1:ap (ee <br /> I V I <br /> �opv SJ <br /> 17 <br /> T) <br /> t� <br /> G <br /> l� d 71 _'_ <br /> FOR DEPARTMENT USE ONLY ( <br /> APPLICATION ACCEMEDBY a 17F V�� DATE: l� ARA' <br /> TAMC,AT OR SUMP MSMCTCTM14 BY DATE fINAL INSPECTION BYJc` n ' 1 DATE / t <br /> ADDITIONAL.COMMENTtI'�� 11 '''' T �M1 • is V w' µ 1 r <br /> 1 V)w G A—C) � is�s �V" <br /> AccoDnnna OnLr' AOI FAC# 4I V <br /> "TOP PEO Iwo AMOUNT RDMI I Ton CIECKPXARH RRENED Sv DATE SN I Rw+T NUMSM INVOICEI <br /> �I <br /> Pub.HBBIUI S., EnvirC. 174(3/96) <br />