SU0008127 - Laserfiche WebLink

Home Browse Search

APPLICATION LIIO WAS PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES' E p P Y ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 '209'468-3420 SEPTIC NOR-RFFUNDARIE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (GIGPIPLE IR TrIPRwtal APPLICATION WHEREBY MADE TO THE SAN JOAWIN COUNTY FOR A PERMIT TO CONRTM/CT ANWOR INSTALL THE WORK DE6CRSE0. THIS APPLICATION IS MADE IN COMPLIANCE WITH MN MADCN COUNTY DEVROPMENT TITLE /CHAPTLERR 99--1110.7 AND THHE STANDARDDSSyOF S.AN XIACIM COU MLIG HEALTH/SFJSVICEY.EKVtAOMwEEWAL HEALTH pNSION. JOS ADDRF6S/DA APPHr �� J/�[/J/ _/�//f�--�7 F/.'-/,J///TiQI>GC Cm /��/'�/r�rG? Lar SIZE OWNER'S NAME 7/M TIARA ,r//a o.i A,DDREse CONTRACTOR _ A/lam/ ULGG2 ADDRESS_ SUS CONTRACTOR AODiRE ee LICE PHONE TYPE OF SEPTIC WORN: NEW INSTALLATION❑ REPAXUAODITION OESTRUCTION❑ WO SEPTIC SYSTEM PERMITTED IF RISUC SEWER IS AVAILABLE WITHIN 200 FEET OF SUILDNG.I PERC T-11001 I NOW MANY APPSENen NSTAILARON WILL SERVE RESIDENCE❑ COMMEMIAL❑ OTHER❑ NUM6ERR OF UVIN0 UMTS:_/NLAMBER OF SEDROOMS: V' NUMSBI OF YNPLO : .• /fh/J' }��{C/ CHARACTER)G ROK TO A DEPTH OF TYIWO fiT/BUAi 601E CHARACTER SEPTIC WATER TASDEPTH PARTME TS IF1TAN140R1[ASE IRIS _ WO TREATMENT PLANT❑ DISTANCE TO NFARUIT: WELL FOUNDATION PROPERTY LINE LIFT STATION 11 SIZE TYPE OF MI— SANT)OIL SEPARATOR IENCL08EO SYSTEMI �Z— •ESY' LEACHING ULE LSI NO.S LENGTH OF LINF6 `yI yA- o / FT O MINCE TO NEAREST:W ,"��V"'IOUNDATION �O`, PRGPERTV INE S _ AUDI SED ❑WIOTN LENOTM DEPTH ONITANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE MOUNDED ❑rT,WIDTH LLNOTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATICAIPROPERTY UNE SEEPAOE PTS U DEPTH SIZE NUMBER DISTANCE TO NEARESTt WELL FOUNDATION PROPERTY LINE NBMPS M WDTN LENGTH^14/ DEPTH/Q/ DISTANCE TO NEAREST:WRla/�FOUNDATION P OPERTY LNE DISPOSAL PONDS ❑\MOTH LENGTH DEPTH DMANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE I HEFESY CERTFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL 8E DONE IN ACCORDANCE WITH SAN JOAOUW COUNTY ORDINA NCEB AND STATE LAWS,AND RULES AND REGULATION OF THE SNL JDAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'ICERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS M=D,I SHALL NOT EMPLOY ANY PERSON N SUCH A MAN"ER AS TO WCOW SI/UECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S MRN0 OR SUS-CO NTRNG ACTNG SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT N THE PETFORMANCE OF THE WORK FOR WHICH THIS SON S PERMIT IS ISSUED.1 SHALL EMPLOY PERSUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL 7 NOW IN ADVANCE FOR ALL IIEOCIPIM INSPECTIONS. COMPETE ORAWNO SELOW. L BIONED K TITLE: DATE' ROT PAN SHRAW TO SCALE]SCALL 1.NAMES OF STREETS OR ROADS NEAREST TO OR ROUNDING THE PROPERTY L RO4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED Z.OUTLINENM OF THE PROPERTY.WITH DENBIONS ANO NORTH DUECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 0. DIMENSIONED OUTLINES AND LOCATIONOPO OF ALL EXIGT"O AND FRISED STRUCTURES, 6.LOCATION DIF WT118 WITHIN RADIUS OF ONE HUNDRED PFTY FT.ON INCLUDING COVERED AREA8 SUCH AS PATIOS,DMEWAYS.AND WALLS. THE PROPERTY OR ADJOINING PROPERTY' 2 ly �r nv PA MENS'.. r dr !y-Z r _ _ FEB A 1999 _ 3 i �,� _ sAr .;G aLRirl L;uylrrr ... THSEWICES ENVIRON,MEN �HEALTHDIVISION- F011 TIMDPI USE ONLY DOIRyRnII APPLICATION ACCEPTED BY DATE: P♦/- (o AREA I TAN(.PIT OR SUMP W CTM4 SY PITT DATE ! I F MAL INSPECTION RV GATE J / 2 ADDITIONAL COMMENTS 3-r+� ` ]ILIA rW0 Vt T FfL- T U 2- �Or� ACCO VNTINO ONLY: AIDI FAfF OO(V 5 PE CODE FEE INFO AMOUNT pEMIITFD CHECK/ SH ITEC FNm 6Y DATE M I F6EMT N �2-6 0 Pub.Health SON-Envlro.174(3/96)