SU0013553 - Laserfiche WebLink

Home Browse Search

A �� 0 �,_ , ,< CPA*- 4"l� ION FOR LIQUID WASTE PERMIT 3� 3 0 �t��•�='SAN-JDAOilN COUNTY PUBLIC HEAL7*4 EIVRONMENTAL HEALDI DIVISION ,I. r `'^r-• n ' ylpt\Qt P.O.ReX A04 IL SAN JOAQUIN ST. STOCKTON,CA 116'614380-:- r16'614380- (209)ISS-3g2C0 S ZL I:F r j I.flR{,"rte MOIFREFU%9ACLE PEAIIU'"Piligs I YEAR FORM DATE ISSUER ICwPra In Try6aa) + APPLICATION a HIUMBY MADE TO THE SAN JOAQUN COUNTY FOR A PERMIT TO CONSTRUCT ANOiOR NYTALL THE WOW D4!9CNSED-THIS AIRJCATIOM 19 MADE N CONRJNRCE VATH IAN JOfbb COUNTY OLVELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOUN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH OrVI1910N, JOSADDIESSUORAhN/_ �C'�� / �.`+r!'"t-'YZG'L<-L�Gr �2G'( CITY L�Ciit�Ixfu' Chat ,(.TZ2�y_LOTS� OWNER'S NAME-.`;�ddJ.t: ?•L�-!��'Y`- ADaREs1 J a m..w .Ja4-5:f CONTRACTOR ,�i fc4i 7 �e ADdEee G uc r IAX z z(F FAow .3 J -S/oS SRRO CONTRACTOR A,DOIESS UCI —PONE TYPE OF SEPTIC WORK: M[IS BISTALLATIOM❑ RY DSSTTRICTION Q NO SEPTIC SYSTEM PHIFKTTFD F P1BU^-SEWER IS AVAILANE WITHIN ZOD FEET OF SUI DING.1 PSITC TSSTM)l 1 IoM MMIT AfrPSSFw I aSTALLATION VAU SONE: IEGIVIEWE G COUMEACIAL A( OTTER❑ IFLBOiI OF—UMTS: IINIEFI/11 ND1100 /: Ml[iM.14111111.01-1110: 5 / 4 CHARACTER OF OM TO A DEPTH pf -A k PITJSUMP SOL CHARACTER � WATER TAME DEPTH ro 0 SEPTIC TANIA71E46W TRAPCAPACfTY NO.CCMPIJT moffI 4 WD MATMINFT RANT❑ DISTANCE TO MIAR[ST: WRL_ Q} FOUNDATIOTWrP.rY LPN� � LFT STATION❑ SIZE TYPE OF PIMP SAND dL SEPARATOR 04CLOOM SMEMI _ LEACFEFS ION ❑ NO.i LENOT"OF LINES LXSTANCE TO WARM:WELL FOI'MDATION PFDF@TrY LINE W.Tll M ❑MOTH LENOTN __DEn" d1TANCE TO NEMER:WELL FSxIpAToN P DPEITY LINE: RODUFM D \0 0 WW�rNLINOTH_ DEPTH DISTANCE TO ELAKW:V431 FOUNDATION_PIOPEEOY S�AOS PTS _SQE NUSYEI dSTANC!TO NEATEST:MUFJJ y FOUNDATION�Q__POP9SrY LTE _ SELMr/ ❑wOTH LENGTH 7EPTH DISTANCE TO NEAIEW:WELD__faWOATON PRd4ARY LINE_ aSSONIL PHOS ❑WOTN Law" mn" DISTANCE TO NEAKff:WELL FOUNDATION POfFRrY UME 1 M"IFEW CERTIFY THAT 1 HAVE PREPAMM TMS APP ICAY"AND THAT THF vmrw wRl Be DINE N ACCOIOAFICE WrrN SMI JOAQUN OOUNrY omxKm=AND STATE LANs,AND;UM ANZI EOUlATTONSOFTNESNIJOAQUN COUNTY.HOME OWNER IM LICE'NSEr AOEM'S IMBNATURE CERTIFIESTHE POILOVANO:'I CEFRY THAT N THE P'EEF+OIMANCE OF THE WOIKEbI%M" TM PflWfT K ISSUED,1 SHALL NOT=L00Y ANY PERSON IN SUCH A MANNER AS TO BECOME VLJICT TO LAORSCMAN"S COMPENSATION LAWS OF CALIFORNIA- CONTRACTOR•/1000 OR SUP-CONTAACTNO SIGNATURE CERFIFES THE FOLMIMMU:'I CERTIFY THAT N XTE PEFrOtWAANCE Of THE WOM FOR WH"THIS PE TXT O ISSUED,1 SHALL.DEPLOY PERSONS SUBJECT TO WOAUAAW S CO MSATION LA CALIFOIlSA.•TI!NL►FVCAMT MUST CA"]{HOURS,M AP/ANC[FOIL ALL S►BCTOIIS. COMPETE OMWMM BELOW. •SNED X - TTTLf: OATL.2/ PLO.I.W TO SCALL] E 1,NAMES OF STIEYTS OR ROADS NEAREST TO OR BOUNDING THE P DPEWY. A.LOCATION OF HOUSE I EWAOC OW-D&AL SYSTEM OR PROPOSED MA 2.OUTLINE OP THE PROPERTY,WITH DENSIONTI S AND NORTH DMECON. EXPANSION OF SEWAGE ONPOSAL SYSTEMS• S. DIMENOONEO OUTLIES AND LOCATION OF ALL EXI TM APO PROPOSED STRUCTURES. S.LOCATION OF WELLS NINON RAGRJS Of OP!WMWM FEW A.OR L� NCLlA1N0 COVETED AREAS SUCH AS PAI/OS,DOWWWAYS•ANO WAUU. THE PROF13M OR ADJOBON PfJOREIW. {� - - AIS ... - - ........ .. .. ....................... �. ..0-_.;.....� .c. . . .. . . _. . <.... .. ..E.... ...5. >.... .. ... _ ....... ... .. ... ... .......... .. ._. .. ....; r.....:. .... , . . PAYMENT ; . .:.. ..,.... : RECEIVED , �- .:.. . .. .. _ . ...... . . . . _ ... . . :.... .. 211995 -�, ..: ...;.....<.......... E 4YAPUnv COAT-Y, PU6LIGHE4LTliSFR1,IC.�S . .. MViflONtiAE'iJTAL!'3E:AlTF'f ' FOR DEPARTMENT USE ONLY APPIJCATgN ACCEPTEC 6Y DATE:`„�y /�2— TAPR,PT OR P)WP INSPECTION BY - DATE ! ! FOLAL NNECTION ry ADDITIONAL COMJAE<TS: 1/ -/fie ACCOPlIIMO ONLY: AIDS F Qw cCLt<FOR'�(t,I' ACs Q K t /S LIrU.�C.--CL•L � �<C�S�V. PE LOO[ PQ IA" AMOUNT REMITTED (CASH RSGDV®SY DATE SR I POMC NIMW SEVdCE S C� tZ fI I Dot 4