Laserfiche WebLink
AP yjjt OA PhR LIOUID WASTE PERMIT <br /> PUS TL SIN C NTY PUBLIC HEALTH SERVICES <br /> �tRl''�'j�JplC`t' �� IR ENTAL HEALTH DIVISION <br /> Sh.S 10xQ „�•�l�}1 �C WEBER AVELE,STOCKTON,CA 95201388 <br /> Gam'Y <br /> (209)468-3420 <br /> SPS <br /> 110111-REFUNDABLE PERMIT EXPIRES i YEAR FROM DATE ISSUED <br /> (Complete in Triplicatol <br /> AI_�.VACAATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PETLMIT APPLICATION CONSTRUCT AND/OR INSTALL THE WOE,DESCRIBED.THIS ALICATION I8 MADE IN COMPU <br /> JSATI UIN COUNTY DEVELOP'199W <br /> MEENTT�TITLE, <br /> CHAPTER�9-)1110.3 AND <br /> �THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION <br /> JOB ADDRESS/OR APN! /9 71 ,/ /Y• /"ai/Z /z_ CITY ( CGC�< LE <br /> OWNER'S NAME �iC(a.0 Lf._ 1`'+�C'q�(Q� ADDRESS j PHONE�� <br /> /A <br /> CONTRACTOR_ ADDRESS LICJ�Z-? .E-�Zl <br /> SUBCONTRACTOR ADDRESS UC/ PHONE_ <br /> +, TYPE OF SEPTIC WORK: NEW INSTALLATION❑ REPANUADDITiON DEIITRUCTION❑ <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 EIFEET OF BUILDING.) ►BIC TESTHI I 1 HOW MANY <br /> • Apq{w$en <br /> INSTALLATION WILL SNE: RESIDENCE w COMMERCIAL❑ OTHER❑ <br /> NUMBER OF LIVING UNITS:_NUMBER OF tEDR00 L—NUMBER OF EMPLOYEES:" <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: ljl{.:y.{c/,Yal WATER TABLE DEPTH <br /> SEPTIC TANK/OREASE TRAP ❑TYPE/MFO CAPACITY NO.COMPARTMENTS <br /> MG TREATMENT PANT❑ DISTANCE TO NEAREST: WELL FOUNDATION f PROPERTY LINE <br /> UFT$TATON❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM) �(OS <br /> 2 p <br /> i <br /> LLEACHING UNE ){.t J/NO.i LENGTH OF INJEB ate—O /k-�'i-� DISTANCE TO NEAREST:WELL_FOUNDATION IJHE_ <br /> FILTER BED E]❑WOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE_ <br /> MOUNDED ❑WIOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE_ <br /> SEEPAGE ERT$ ��`�F��T❑�1 DEPTH SITE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE_ <br /> SUMPS r-WIDTH LENGTH /�!DEPTHS DISTANCE TO NEAREST:WELL FOUNDATON�POPEMY UNF_ <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> — <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 LAI <br /> AND REGULATIONS OF TUE SAN JOAOVIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWINO:'I CERTIFY THAT IN THE PERFORMANCE OF THEW <br /> r THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN H A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." CONTRACT <br /> SVS-COM TING N I THE FOLLOWING:"C S THAT IN THE PERFORMANCE OF THE WOFBC FOR WHICH THIS PERMIT IB ISSUED,1 SHALL EMPLOY PERSOI <br /> WOMMA 'S COMPS TION WS C LIFORII T C_ALL 24 HOISLL M ADVANCE F/0/11/yALL REOUIRID INS►ECTIONS. COMPLETE DRAWING BELOW, <br /> SIGNED X TLTLEi_146" DATE: 7 3c <br /> o� PLOT PAN(DRAW TO SCA.SCALE 'to <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR <br /> 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING ANO PROPOSED STRUCTURES, S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRE <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DPVEWAY8,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY <br /> )eaN <br /> 7-o <br /> . <br /> rIR <br /> Al 3 01996. <br /> u ..;C HEALTi-i SERVICES <br /> HEALTH 6IV(IS!GF <br /> �_ FOR DPARTMBIT USE <br /> ONLY /lam <br /> APPLICATION ACCEPTED BY , DATE: 7 v <br /> AREA: G <br /> TALK,PIT OR SUMP INSPECTION <br /> BY DATE / / FINAL INSPECTION BY DATE <br /> ADDITIONAL COMMENTS: <br /> r <br /> ACCOVNTIN6 ONLY: NDF FAC/ <br /> PC CODE FEE 1NFO AMOUNT REMITTED CHECK/ ASH RECEIVED BY DATE 611I NUMBER INVOICE <br />