Laserfiche WebLink
POIC TESTI01 (I UDR WAY <br />Appleafer, f <br />. .. <br />: <br />'PAYMENT. <br />7 <br />:JUL 1996 • <br />:•-4b4N1-40A0tilisl L:bUiv•Pri ..... • <br />PtLIG HEAL1tH--SERICS :•• <br />: : • : <br />APPLICATION FOR LIMO WASTE PERMIT <br />SAN 'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 388. 304 EAST WEBER AVENUE. STOCKTON, CA 95201,388 <br />1201) 481-3420 <br />11011-REFUllaBlE P *jEXPSESJ YUS.S pin MVO <br />lessolsbI TrIplhats) <br />APPUCATION 18 PITHERY MADE TO THE IAN JOAQUIN COUNTY FOR A PENLITT TO CONSTRUCT AND/011 INSTALL WE WOW DISCUSSED. THIS APPLICATION IS MADE IN COMPTJAMR VirrH SAN <br />JOAOUIN COUNTY DEVELOPMENT MLR CHAPTER 1 1 10.3 AND Mit VIANDANDS OF SAN JOAOUIN COUNTY PLISUC HEALTH INPVICER. ETWTROXIMENTAL HEALTH 017n. ern <br />J06 ADDIMMOR APNO 1/7/?cm, /2"4/t/i7E04- <br />57E /e- ttrif ,t,tom as 5-floyei,y's,„:4 <br />,êin j 59,- , 4//45,A.) LICE ,43t1R33NE 7 ,,,..E <br />(JCS <br />OWNERS NAME <br />CONTRACTOR <br />SUS CONTRACTOR AODPIESS <br />TYPE OF scrne Wow NEW INSTALLATION 0 1 REPPITUADDITION Pfs, <br />IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAIL:46LE WITHIN 200 FEET OF tHIADING.I <br />INSTALLATION INILL 'EWE, REINDENCE CLIC._ COMMERCIAL a unix. CI <br />NUMIIER OF ILTYRIO UMT16_ NUPASER op flexamoiirs. .2— NUNISER OF ablift0 VWS <br />UFT STATPON 0 SIZE TIRE OF P./MP <br />LEACHING USE <br />SUMPS 0 WIDTH LENGTH <br />DISPOSAL PONDS 0 won.' LENGTH <br />RIM% UV LENGTH <br />MOUNDED LENGTH <br />&WW1 PITS SIZE <br />PLNO.A LENGTH OF LINES z24/C' <br />0 WIDTH <br />0 WIDTH <br />0 Demi <br /> SAM) OIL SEPARATOR [ENCLOSED WETTER <br />496" -24— INSTANCE TO NEWEST, P41116-a rcamaxknom IS 14— mammy (SW <br />FOUNDATION PROPERTY LINE <br />FOUNDATION <br />FOUNDATION <br />PRoPECIRY UNt <br />Harem UNE <br />DATE: <br /> i <br />, <br />Deangtemie 0 <br />DEPTH CHARACTER OF SON TO A DEPTH OF 3 y PITNIUMP SDK CHARACTER, '54-7f--0 WATER TAME / 57. <br />TANIUGREASE TRAP 0 TYPE 5510 CAPACITY NO. COMPARTMENTS <br />PRO TREATMENT PLANT 0 DISTANCE TO PARAPIPST: WELL <br />DEPTH <br />DISTANCE TO WAIVER . WELL <br />DEPTH <br />INSTANCE TO NEAREST WELL <br />NUMBER MST MICE TO WEARER, WELL FOUNDATION PROPERTY LINE <br />DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PPCPETRY LW <br />DEPTH INSTANCE TO NEAREST: WELL FOUNDATION PFNIPEPITY ME <br />I NEWSY CERTIFY THAT P HAVE PREPARED THIS APPUCATION AND THAT TIN WORK WILL SE DONE RI ACCORDANCE WITH SAN JOAOUIN couNrx OFOINANCES MAD IRATE LAWS, AND RULES <br />ANCHREOULATIONI Of THE SAN -MAC/DIN COUNTY. HOME OWNER OR LICENSED AGENT'S INONATURE CERTIFIES THE FOLLOWING: 'ICEPITTFY 'THAT IN TIM MEOW/ANC! OF TISE WOW FOAWHICH <br />THIS PERMIT IS ISSUED, I SHALL PIOT EMPLOY ANY PERSON IN SUCH A WNW, AS TO BECOME SUBJECT TO 1401110JANS COMPENSATION LAWS Of CALIFOISIA CONDIACTOPTIHM1110 OP <br />1346-CONTRACTIFIG SIONAHIPIE CERTIFIES THE FOLLOWING: 1 CERTIFY THAT IN THE PEISORMANCE OF THE WONI P00N/16CH THIS PERMIT IS ISSUED, 1 *HMI EMPLOY PERSONS 1106.1PCT TO <br />woM(MAN'S COMPENSATION LAWS OF CALIFORWA.• THE Alnic‘usr M T CAL 24 siousto IN AOVANCS POR ALL REITAIMEO INSPECTIONII. COMPLETE (*AWNS) Moro. CZ) <br />/-/yrf-0 ,&e- Traf: DATE <br />PLOT PAN IDRAVE TO OCALEI SCALE <br />NAMES OF STREETS OR ROADS NEAREST TO OR TIOUNDWO THE PROPERTY <br />OUTLINE OF TFIE PTI3pERTy. WITH OILIENOIONS AND fooffT31 DIRECTION, <br />DINIENSANIED OUTLINES MID LOCATION OF ALL EXIIIINO AND ANDPOINO STRUCTURES, <br />wciumes COVERED AREAS SUCH AS PATIOS, oRovewAYe. AM) WALKS. <br /> <br />I • <br /> <br />LOCATION OP HOUSE IIEWN3, DISPOSAL SWUM OR PROPOSED <br />EXPANSION Of SEWAGE DISPOSAL SYSTBIAS, <br />IT LOCATION OF WELLS WHIN RAMPS OF ONE HUMMED FIFTY PT. ON <br />THE PROPERTY OR ADJOINING PROPERTY. <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED WY <br />TAW, PIT OR SUMP INSPECTION SY DATE / / FINAL INSPECTION SY <br />MNNTIONAL OCIANTENTS: <br />ACCCILINTINO ONLY - AID, <br />FAGS <br />Ff Cora IL <br />S. <br />FIX INFO <br />4..... <br />AMOUNT ROMITTED HECK/ AIN <br />Ao. . <br />RECOVER) ST <br />.. . <br />DATE I MIDST PRAWN INVOICE f <br />11 2_ 10 Hs" I eo 11 4,534, L6 7 /1 lq(0, 4 .3 1 0 / S <br />L S ftit Li nii-iiE) .