SU0003025 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR LIQUID WASTE PERMI. _ SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES E ENVIRONMENTAL HEALTH DIVISION j P.O. BOX 388, 446 N. SAN JOAQUIN ST., STOCKTON, CA 96201-0388 1`I✓ (2091 4683420 MON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM GATE ISSUED IComphto in Triplicate) APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOR(DESCRIBED. THIS APPLICATB)N 18MADF AOMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESS/OR APNF ,J ) ��_-� N'� Cm, 1 _ Y� LOT SIZE_ OWNER"S NAME I'I V ADDRESS �� l u 5 H�7 l' C/ Til' 7 / PHONE CONTRACTOR �1 `" , � ADDRESS (�1 /� LICK M40NE SUB CONTRACTORO - �'»'�-P ADDRESS 4`Z3 � �,C,I Vo C ----- LICK MINE_ TYPE OF SEPTIC WORK: NEW INBTAl1AT10N� r-- REPAIVADDITIO ❑ DEJTRUCTION F, \ ■ IND SEPTIC SYSTEM PERMITTED IF WBUC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) V` PEiC TESTHI I I NOW MANY INSTALLATION WILL BEAVERESIDENCE❑ COMMERCIALy�Wgpoleetlon I 1 \ OTHER ❑ S c NUMBER OF UVING UNITS: NUMBER OF BEDROOMS: HUMB61 OF EMPLOYEEa: CHARACTER OF SOIL TO A DEPTH OF O FEET:_ WATER TABLE DEPTH r D / Q : SEPTIC TANK/ORFASE TRAP QT�YPE/MFp qT/SUMP SOIL CHARACTERCAPACITY, / �6-g � /��/�Ay PKD TREATMENT PLANT ❑ DISTANCE TO NEAREST; WELLNO.COMPAgTMEMB PROPERTY LINE FOUNDATION UFT STATION❑ SIZE TYPE OF WRAP SAND OIL SEPARATOR(ENCLOSED SYSTEM)T- (� n LEACHING LIME IB--NO S LENGTH OF LINES /h b "� DISTANCE TO NEAREST:WELL 6 FOUNDATION LT..��/ FILTER BED 13 WIDTH LENGTH �5`_/.. PROPERTY LINE 1 7 DEPTH DISTANCE TO NEAREST:WELL MOUNDED ❑WIDTH FOUNDATION PROPERTY LINE_rZ�-� R�� LENOT DEPTH DISTANCE TO NEAREST:WELL FOUNDATION SEEPAGE PITS L1 DEPTH SIZE NUMBER_a_DISTANCE TO NEAREST:WELL A A PROPERTY LINE SUMPS ❑WIDTH FOUNDATION �OpE�y LINE�� LENGTH DEPTH DISTANCE TO NEAREST:WELL DISPOSAL PONDS ❑WIDTH FOUNDATION P OFERTV LINE LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY`UNE I HEREBY CARTONS THAT I HAVE JOAQUIN C THIS APPLICATION ANO TMgT THE WOPX WILL BE DONE IN ACCORDANCE WRH SAN JO ERTIF COUNTY HEINANCES AND STATE LAWS,AND HIGH AND REGULATIONS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT IN THE PERFORMANCE ST THE AWS.FOD WHO. THIS PERMIT 19 ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WOMMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUB-0ONTRAC M SIGNATURE CERTIFIES THE FOLLOWING: 9 CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S C MPENSATIOATION LAWS OF CALIFORN NOlM6 IN ADVANCE FO NIA.• THE APPLICANT MUST CALL R ALL REQUIRED INSPECTIONS, COMPLETE DRAWING BELOW, SIGNED X l TELE:L:�biV-N{ PLOT PLAN MRAW TO SCALER SCALE / Lr_ 1. NAMES OF STREETS OR ROADS NEAREST TO OR ADMIRING THE IRI,,,. ro OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WAMS. S. LOCATION OF WELLS WITIIIN RA1111 OF ONE HUNDRED FIFTY FT.ON TY ------�-yB/�(--�yJ�. THE PROPEROR ADJOINING PROMOPEgry. ' VI's F` I AUG 2.2. 199x. (fit 1, go Ln/ L"CH •.J,.,J VIRI:)NMF rq�c r},SERVICE;. Nf4LTHDIVIS1Unr c q o Q' w CFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .J \ i. . /L�_ - _ _ C DATE: Z TANK,PIT OR SUMP INSPECTION By AREA: DATE FINAL INSPECTION BY n ADDITIONAL COMMENTS I 1 DATE R ACCOUNTING ONLY: AIDN `� FACN PE CODE FEE INFO AMOUNT REMITTED CNECKN ABH RECEIVED BY DATE BR I PERMIT NUMBER INVOICE SaSDIdD