Laserfiche WebLink
r oe)ovz's- - <br /> APPLICATION FOR LIQUID 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 96201-0390 <br /> (2091 4871-3420 <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE MSUED <br /> KC plssm u TI}loul <br /> APPTICATiON IE HEREBY MADE TO THE IRAN JOAGUIN COUNN FOR A PEFIRAR TO CONSTRUCT ANNOR ITESTALL THE WOW OEVCPoBM.TIM APPUCATkDN 16 MADE IN COMPUANCE�d H SMI <br /> JOAQUIN CooNTY DEVELOPMENT TITLE.C AAPTER 9-1110.3 AND THE STAHOAADS OF SAN JOADUMI COUNTY MVAC HEALTH SE IVCES,ENVIRONMENTAL HEALTH H4BIOH. <br /> JOB AGOIESGilR AJYIf U �. CT' r9Y ILL. (Ct!ALDT BEEF <br /> OWRJER"s NAME` ADOIEBB 105 2 041kx\- Aim "11:1464.C M 9'y4y0 PFIDNEy7J-I /� <br /> CONTRACTOR_ AmREsn i L D N. Lu YL.So1♦ LICr x59343 R10Nr� <br /> BUB CONTRACTOR_ AOOIE66 UCr PHONE <br /> TYPE OF fi7•RC WORE: 019W INSTALLATION❑ PMASVAOSITION OFNTRLICTION❑ <br /> [NO SEPTIC SYSTEM PEPWTTED IF PUBLIC MvER IS AVAILABLE WITHIN 200 FEET OF aUILONO.H FeD TEiST(4H 1 11bYI MANY <br /> QwI V.-3k-kk+ wAE�NR f_ <br /> MSTAMATION MALL SONE KBRIL-NCE bt COMMERCIAL 10 OTHER❑ <br /> CN`�eel of U�_V1(�1jo�l��j1�T�a�s�yL�� N;.HaM oP aEonooMs:,�l,�r_L1 wLw�i OP YEPLo7�E•, 3 ~�� (_ 20 o o <br /> DF SD IC70 PTlEM1T OF 7 F!.!TLEFILIM,WT(SUMP SOIL CHARACTER' ��Q yy//2C WAT AHE D�TI�{�I 11.0 Q,�l <br /> sIPTIC TANSAUREASE TRAP LPiWEA1F0 Y L CAPACITY 3200 C1Q I NO.COMPARTMMS �. GO N1•Tec-k.( <br /> PK-TREATMENT PUNT❑ DIATANCE TO W-MEST: WELL- FOUNDATION PNOPEIITY UNE <br /> 10 I L <br /> liT STATON❑ SIZE TY'{OF NMP SAFp,OIL SEPARATOR IEIKLOSFD 9Y5TOAI _ <br /> LEACHING UNE N1C3P NO S LENGTH OF UNEC rI DISTANCE TO NEAREST:WELL ro '/ FOuAPROPERTY LINE <br /> "TeI SEG Alp I' L7,LVIDTH �4f u-m:, AQL Dwrm to FFOUNDATION_UBTANCE TO NEAREST WELL /ZSLII�FOUNDATION 1-0' N <br /> QL ENRMY UINE�� <br /> MOUNDED 'V ❑WIDTH LENGTH- DEPTH MST ANCf TO NE-MST:WELL fOU.NOATION PROFMWR LINE <br /> GE <br /> SEEPARTS ❑DEPTH aLZE NUMBER DISTANCE TO NEALEST:WELLKNNDATION PROPERTY UNE <br /> sUAM ❑WIDTH LENGTHOLPTN DISTANCE TO NEARF9T:WTIL FOUNDATION PROPERTY UNE <br /> MSPoµL PONDS ❑WIDTH UE NGTH__DEPTH DISTANCE TO WARIEST:WELL—FOUNDATION PROPERTY UNE O <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APFVCATION AND 1 HAT THE WOR(WSL BE DONE IN ACCOADMCE WITH SJJJ JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND PEGUL ATIONS OF THE SAN JOAGUIN COUNTY,HOME OWNEa OR UCENSED AGENT'S EDNATURE CERTIFIES THE FOLLOVOAG.'1 CERTIFYTHAT IN THE Pe FoASAANCE OF THE WORK FOR WIC" <br /> THIS PERMIT Is ISSUED,I SHALL NOT EMPLOY ANY PERSON NN SUCH A MANNER AS TO SECOME SUBJECT TO WORKMAN•R.COMPENSATION LAM O CALIFORNIA.- CONTRA'araws IEENT M <br /> SUG,CONT RACTING SIGNATURE CFRT—ES THE FOUOYMNG:'I CERTIFY THAT IN THE RERFORMANCE OF THE WORK FOR'AMKH THIS PENATT IS ISSUED,I AHALL WKDV PERSONS RUI&JECT TO - <br /> WOW MANY COMPENSATION LAWS OF CA MRMA.'THEA 7 'ST CALL M"D IN ADVANCE FOR ALLJISM11 <br /> OLID INSP/C0NS. COMM.RE OMNO BELOW.. <br /> f <br /> / y 7 p) If N1F' <br /> SIGNED X TITif:_ � �l 5 DATE: C/7 <br /> PLOT U <br /> PN(DRAW TO 9CA.E)SCALE In <br /> C^7 <br /> I NAMES OF STREETS OR ROADS NEAREST TO 09 BOUNDING THE PROPEMTY- 4.LOCATION Of HOUSE SEWAGE OIEV SAL SYSTEM OR FPOFq SED Ovv <br /> Z.OUTLINE OF TNF PROPERTY,WITH DIMENSIONS AND NORTH DPECT-1 LXPAN910M OF SEWAGE DISPOSAL BYT ME. N <br /> 7.OIMENSIONED OUTLINES AND LOCATION OF ALL EXALTING AND PROPOSED GTHUCTUI`ES. S.LOCATION OF WALLS WITHIN RADIUS OF ONE MNDPfp-IFFY FT.ON 41 <br /> INCLVUINO COVERED MEAS SUCH AS PATIOS.DRIVEWAYS AND WALXS THE PROPERTY OR ADAHINO PROPERY. <br /> -I I Qu T1911. O I IS RII 4 A'4 <br /> - _ — <br /> F .. <br /> I . I <br /> - — — <br /> V <br /> - ! -'u3 <br /> ... <br /> x. I <br /> - <br /> - �tea- _. I=-=►- --- __ _ _ <br /> d <br /> OH <br /> _ <br /> ` <br /> 1 <br /> r-- -- -i-- m NT <br /> JUN: -7 1995 <br /> FOR DEPARTRAOTT LSE ONLY AL HEALTH DIVISION <br /> APPLICATION ACCEPTED BY DATE. • 4 AREII•�/�q <br /> TANK,M OR GUMP W W C TATE I I FINALINSPECTION BY <br /> ADORTRMIK COMMFIlT9: 6� (3". <br /> _ <br /> ACCOUNIIWJ ONLY. ANDS FACE l/77 V <br /> d'rA-h ps <br /> PE CODE FEE INFO AMOUNT REMITTED CNEC ALN RBC ENED aY DATE M 11'b1REi MlNiel INVOIC9f <br /> 47_15 250 2S�-oo ��S (�j 6 rl4Cp 30S`1 <br /> 5 <br /> l <br />