Laserfiche WebLink
APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P,O.BOX 388,904 EAST WEBER AVENUE,STOCKTON,CA 95201388 ��� <br /> (209)488.3420 S�p <br /> MON-REFUNDABLE PERMR EXPIRES 1 YEAR FROM DATE ISSUED <br /> (rAmp1tS6 In Trolkflf) <br /> APPLICATION IB HEREBY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IB MADE IN COMPLIANCE WITH CAN <br /> JOAQUIN COUNTY DEVELOPMENT <br /> TIT LF. <br /> -CHAPTER 81110.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICER,EWRONMENTAI HEALTH 04M910N. ��(/n <br /> JOB ADDRESSIIR APNF lJ I BV �• /�" I ,�L-Z CRY Awo/ J LOT BQEQ"/ <br /> OWNER•SNAME /e• -/ DPESS V 'DD L-00i W• RION�3J <br /> CONTRACTOq ADDRESS LICE PI/ONE <br /> BUB CONTRACTOR ADDRESS LIC) RHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPARIADDITION❑ DESTRUCTION❑ <br /> IND SEPRC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 2DO FEET Of BUILIXNO.I PERC T[STNI I U HOW MANY <br /> pl-Sen <br /> INSTALLATION WILL SSRVE: RESIDENCE❑ COMMERCIAL❑ OTHER /I Aql <br /> ���FFE <br /> NUMBER OF IMMO UNITS: NUMSER OF SWROOMS: NlSla9l OF iMROYEL: v /f/� �� /_�y A, <br /> CHMACTER Of SOIL TO A DEPTH OF�3 yFEE�T;�� PFTMUMP SOK CHARACTER: ��7 WATER TABLE DEPTH GY"fJ / <br /> RFAt y6}ircrrAFO , CAPACITY - T+-L/ NO.COMPARTMENTS <br /> MCO TR RANT DISTANCE TO NEMUT: WELL ✓� FOUNDATION PROPERTY UNE <br /> UFT fTATION❑ SIZE TYPE OF RUMP BAND OIL SEPARATOR)ENCLOSED SYSTEM) <br /> LFACHNO LAME ❑ N0. OF LINER b19TANCE TO NEAREST:WELL FOUNDATION F110 FIE UNE <br /> RLTER BED Cl WIDTH LENGTH dSTANCE TO NEAREBT:WELL FOLR40A UNE <br /> MOUNDED ❑WIDTH LENGTH DEPTH ERRE FOUFIOA7ION PNOPEITTY UNE <br /> SEEPAGE FITS ❑DEPTH BQF NUNaE NC <br /> TO NEAREST. UNDATON PROPERTY LSLE <br /> SUMPS ❑WIDTH OEPTN DISTANCE <br /> TO <br /> NEAREST:WELL FOUNOATON RTY LINE <br /> IXtFpfAI IONDt ❑ �LFNGTH_ <br /> OF <br /> DISTANCE TO NEA REST.WELL FOUNDATION PROPERLY UN <br /> L� <br /> I HEREBY CETRIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND Mug �L <br /> AND REGULATIONS OF THE BAN JOAQUIN COUNTY.HOME ONRER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWIWML <br /> ;'R CERTIFYTHAT IN THE PERFOANCE OF THEWORK FOR WMCH �{ <br /> THIS PERMIT 19 I9SUED,I SHALL NOT EMPLOY ANY FERSO I M SUCH A MANNER AS TO BECOME SUBJECT TO WOIKMAN'S COMPENSATION LAWS OF CAUFORNUL.' CONTRACTOR'{HIRING OR <br /> SUB-CONTRACTING SIGNATURE CER)FES THE FOLLOWING:'I CERTIFY THAT R THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SMALL EMPLOY PERSONS BLUBJECT TO (� <br /> WORM TION LAWS Of C FORMA' THE APRICART MWT CALL 31 HOI1116 M ADVANCE f011 ALL REOLARm BIfP�E1C71/0-M/. COMPLETE DRAWING BELOW. r` <br /> SIGNED X TITLE: -57-/ L ( p DAR: " ` <br /> d <br /> ROT PLAN WAW TO SCALE)SCALE <br /> 1 ATwccrR OR GB11E�IfF�m nB BOUurKNO.THEEmFERRY. R EACATTON OF TI M BEWAW DISPOSAL IYfTBE <br /> _ EM_ .R 9.. <br /> Al <br /> I ; f <br /> inns('046 ;..... <br /> �t ;, I i 1 I ��I Q I ..• ���L` 7; [S-oL.l'TW7-D V41F <br /> �? a't•.:r',�r�. <br /> :. <br /> MAY 219967 <br /> \ + <br /> SAN,(�AQUIN COUF{i- <br /> 'i 1 I I PU I� LTH SER%iC5 <br /> cNVIR�WL HEATH DIV 'ION <br /> —_APPLICATION ACCEPTED BV _ pATE� ` AREA 1 <br /> TAMC,PR OR SUMP INSPECTION BY DATE I I FIIIILL INSPECTION BY <br /> AOOIlIONAI COMMENTS:�/ %Jf/ld� �h F e' �r <br /> ACCOVN TING ONLY: AID, FACT <br /> FE CODE FEE INFO AMOUNT REMITTED NEC ASN RECOVER BY DATE M I PERMIT NULaBI INVOICE <br /> d� OLS <br />