Laserfiche WebLink
PHONE <br />UCfCONTRACTOR <br />.UCf BUB CONTRACTOR <br />REPAIR/ADtNTIONTYPE OF SEPTIC WORK: <br />P®C TEST(t) ( 1 HOW MANY(NO SEPTIC SYSTEM PERMITTED IF PUBUC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) <br />AppSoatfon f_ <br />OTHER RESIDENCE COMMERCIALINSTALLATION WILL SDWE: <br />NUMBER OF UVINO UMTS: <br />PROPERTY UNE FOUNDATIONWELL <br /> / <br />PROPERTY UNE FOUNDATION LEACHING UNE <br />PROPERTY UNE DISTANCE TO NEAREST: WELL FOUNDATION.DEPTH LENGTH ALTER BED <br />PROPERTY UNE DEPTH MOUNDED <br />L PROPERTY UNE DISTANCE TO NEAREST: WELL.NUMBERSIZE SEEPAGE ATS <br />PROPERTY UNEDEPTH LENGTH SUMPS <br /> PROPERTY LINE DISTANCE TO NEAREST: WELL.DEPTH LENGTH DISPOSAL PONDS <br />DATE:.TITLE: SIGNED X <br />• to TDRAW TO SCALE) SCALE.PLOT <br />'blA *s i • :U..: <br />ztt <br />.if..: <br />FOR DEPARTMENT USE ONLY <br />DATE­ APPLICATION ACCEPTED BY <br />7 <br />FACfAIDSACCOUNTING ONLY: <br />BR/PERMIT NUMBER INVOICE fRECBVED BYAMOUNT REMIITEDFEE INFO <br />(IS <br />Pub. Health Serv. • Envlro. 174 (3/96) <br />DISTANCE TO NEAREST: WELL FOUNDATION. <br />FOUNDATION <br />DISTANCE TO NEAREST: WELL FOUNDATION <br />FOUNDATION <br />AND REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME O' <br />THIS PERMIT IS ISSJH»^I SHALL NOT EMPLOY ANY PERSOIf <br />SUB-CONTRACTII <br />WORKMAN’S COl <br />APPLICATION FOR LIQUID WASTE PERMIT <br />Sm. JOAQUIN COUNTY PUBLIC HEALTH SuJVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 468*3420 <br />4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />5. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. ON <br />THE PROPERTY OR ADJOINING PROPERTY. <br />j WATER TABLE DEPTH *-> O <br />NO. COMPARTMENTS <br />DATE / f FINAL INSPECTION BY_ <br />^2 <br />PHONE_ <br />PHONE. <br />LENGTH <br />^HECg/TCASH <br />PE CODE <br />AREA: <br />DATE <br />NUMBm OF BEDROOM^ NUMBHt OF »APLOYEES: <br />CHARACTER OF SOIL TO A DEPTH OF 3 ptr/SUMP SOIL CHARACTER^* <br /> TYPE/MFG CAPACITY <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS, ANO RULES <br />OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: T CERTIFY TH AT INTHE PERFORMANCE OF THE WORK FORWHICH <br />CH A MANNER AS TO BFTQMF 81 IB IELI IU VU^IV.MWI’S COMPENSATION LAWS OF CALIFORNIA.’ CONTRACTOR'S HIRING OR <br />JXlFY THATJUJUrrtl^ORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL EMPLOY PERSONS SUBJECT TO <br />frCALL 24 HOURS IN ADVANCE FOR AU REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. <br />7^3 ■ 7/7bADDRESS ___________ <br />-ADDRESS <br />(7 <br />r <br />PATE z W» / FCTMIT NUMBER few 7^0 7 <br />DESTRUCTION <br />BSJJKLJ SHALL NOT EMPLOY ANY PERSOWIN S0( <br />IND SIGWKjJRE CERTIFIES THE FOLLOWING: ’I CEI <br />impensatioKlaws OF CAUFORNIA.’ TljE APPUCj <br />NEW INSTAUAT1ON <br />NON REFUMDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />(Complsts in Trlpliests) <br />APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INST AU THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPUANCE WITH SAN <br />JOAQUIN COUNTY DEVELOPMENT TITLE. CHAPTER 9-1110.3 ANO THE STANDARDS OF SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES. ENVIRONMENTAL HEALTH DIVISION. > <br />JOB ADDRE88/OR APN»_ | 0(00 Jj. CocO-tA crrY ____________LOT 8IZE^^ <br /> OWNER’S NAME. \JddL^ /xyc addressT <br />TANK, PIT OR BUMP INSPECTION BY <br />ADDITIONAL COMMENTS: <br />SEPTIC TANK/QREASE TRAP <br />PKG TREATMENT PLANT DISTANCE TO NEAREST: <br />UFT STATION D SIZE TYPE OF PUMP SAND OIL SEPARATOR (ENCLOSED SYSTEMI <br />^S^NO. A LENGTH OF UNES STANCE TO NEAREST: WEU£ <br /> WIDTH <br /> WIDTH <br />EPTH. <br /> WIDTH <br /> WIDTH <br />1. NAMES OF STREETS OR ROAD8.NEARE8T TO OR BOUNDING THE PROPERTY. <br />2. OUTLINE OF THE PnOPERTYrWITH DIMENSIONS AND NORTH DIRECTION. <br />3. DIMENSIONED OUTLINES AND LOCATION OF AU EXISTING ANO PROPOSED STRUCTURES. <br />INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS. AND WALKS.