SU0004195 SSNL - Laserfiche WebLink

Home Browse Search

a S AQUIN COUNTY PUBLIC HEALTH SERVICES 5r7 VNVIRONNIENTAL HEALTH DIVISION / P,O, BOX 388, 304 EAST WEBER-AVENUE, STOCKTON, CA 95201388 (� (209) 4GB-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (Complete in TTiplicat@) APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH SAN ,AMIN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110. AN THE STANDARDS OF S N IOAQUIN COUNTY PUBLIC HEALTH SER S.EN FONMENTAL HEALTH DIVISION. M ADDRESSOR APNI lt)' - C1 �I LOT SIZE OWNER'S NAME ADDR Y ` �l/�.�/L' PHONE )NTRACTOR ADDRESS \771—f- LIC/ PHON SUB CONTRACTOR ADDRESS LIC) PHONE (P£OF SEPTIC WORK: NEW INSTALLATION REPAIR/ADDITION ❑ DESTRUCTION ❑ 10 SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TEST(-)( I HOW MANY �,{/ AppKmtlon INSTALLATION WILL SERVE: RESIDENCEILI COMMERCIAL❑ OTHER❑ UMBER OF LIVING UNITS: NUMBER OF BEDROOMS:- NUMBER OF EMPLOYEES: HARACTER OF SOIL TO A DEPTH OFT-3 FEET, PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANK/OREASE TRAP L3-I YPEIMFO LC CAPACITY 1,1200 NO.COMPARTMENTS KG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) . _ LEACHING LINE CI�NO.d LENGTH OF LINEr�21 '�© ' DISTANCE TO NEAREST:WELL .0 FOUNDATION �' PROPERTY UNE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE IOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE i EEPAGE PITS ^ (STANCE TO NEAREST:WELL1!W FOUNDATION PROPERTY LINE �{ V l SUMPS �l�J WIDTH LENGTH0 DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE 1SP09AL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE N ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.IIOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR VB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO VORKMAN'8 COMPENSATION LAWS OF CALIFORNIA.' APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL LREQ,UUI�RRED INSPECTIONS. COMPLETE DRAWING BELOW. fin/ - q SIGNED X TITLE:-`'�F1-�lL� DATE: / _/s PLO N(DRAW TO SCALE)SCALE 'to {. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDI G THE PROPERTY. 4, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6, LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON MCLUDINO COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. .. .. _._. LA ....... ...:. . .. ............................. .. ..:.....: .. .. . %e .....<............ .... . ......... : ........ W w� >..... ......;...... ...... :....................:.. .. ............... .......... .......... ............ . .. ,.........._...... ...... ;.....:.......... . <..... .....s.... ... : ..... .. �r a Iv�'cs Q .... .. i� _. . .... .>. ..:..... ................ EF .3 1 . `�..........;. PUdLIC FWALT4 gl f1V10E� . .•=NVIRONMME NTAL HEALTH OfVfSio P': 2` �-xloxt� 12-0 ---------------- w