Laserfiche WebLink
ArrLIGAIIUN rUH LIUUIO WASTE PERMIT <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 446 N. SAN JOAQUIN ST, STOCKTON, CA 96201.0388 <br /> (209) 468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Csmplsts in Tripliuts) <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> DAOUIN COUNTY DEVELOPMENT TITLE.CHHAPTERR 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. <br /> "`%8 ADDRESSOR APNF r<�..�'7'IS L.rSTP/Y 1dCffY 4� � 7r% LOT SUE <br /> ^LONER'S NAME _ ADDRESS t PHONE <br /> `ONTRACTOR J 4A! \N fm's ^F- A0< ADDRESS/ 'x.. fj QN.l�.':.. LIC# '. f ' PHONE <br /> SUBCONTRACTOR ADDRESS 1C'-T1 LIC# RHONE <br /> VPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRJADDITION Av DESTRUCTION <br /> •SAO SEPTIC SYSTEM PERMITTED IF PUBUC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) FERC TESTW I I HOW MANY <br /> �c, Appliaeeon t <br /> STALLATION WILL SANE: RESIDENCE-LJ COMMERCIAL 13OTHER 13 <br /> —_WSER OF LIVING UNITS: NUMBER OF BEDROOMS: -J NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OFF3/FEET: PfT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> :PTIC TANKIGREASE TRAP ;LSI TVPE/MFG�f/L�''C 7- I Cr CAPACRY F,G Ui! NO.COMPARTMENTS i. <br /> :G TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> C <br /> tiPT STATION 13 SIZE TYPE OF PUMP SAND_OI0EPAMTOR(ENCLOSED SYSTEM) <br /> LEACHING UNE ,_E9 NO.SLENGTH OF LINES DISTANCETONEAREST:WELL I6h' FOUNDATION PROPERTY LINE - <br /> ... ' <br /> .TER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> T. UNDER ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION_PROPERTY LINE <br /> SEEPAGE RTS -0 DEPTH �2 � WE 4 Z NUMBER 2-- DISTANCE TO NEAREST:WELL/bV F FOUNDATION PROPERTY UNE "•� <br /> RAPS 13WIDTH LENGTH - DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> �SPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> ID REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:')CERTIFYTHAT IN THE PERFORMANCE OF THE WORT FOR WHICH <br /> 1S PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECTTO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR <br /> .B ONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT IS ISSUED'I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THE APPUCANT MUST CALL 24 HOURS IN ADVANCE MR JALL REQUIRED INSPECTONS. COMPLETE DRAWING BEL/OW. <br /> .HED% 1�a'z f +[ /><L"I TITLE: DATE: e/i,! <br /> ,•�f `^•+1 PLOT RAN(DRAW TO SCALE)SCALE_1 I. <br /> ' NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> OUTLINE OF THE PROPERTY,WITH DIMENMNS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, T�f\ T^.� <br /> S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY PT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRVEWAYS,AND WALKS. .V THE PROPERLY OR ADJOINING PROPERTY, <br /> .. y .......... <br /> .._.. <br /> II - _. .i.... .._ <br /> I T f.�� F <br /> CCl <br /> .. If <br /> I m4 .. <br /> I <br /> L <br />