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APPLICATION FOR LIQUID WASTE PERMIT 60/15S <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOLLREFUIIDARIE PERMIT EXPIRES I YEAR FROM GATE ISSUED <br /> ICewplete 1■Trlpliute) <br /> APPLICATION Nil IEREWY MADE TO THE BAN JOAOU W COUNTY FOR A PERMIT TO CONrTTRUCT ANOMR INSTALL THE WOKS(DESCRIBED, THIS APPLICATION IS MADE M COMPLIANCE WITH BAN <br /> JOAOUM COUNTY DEVRVP%WNT TTTLIC CHAPTER 9-1110.3 ANO THE ITANOA DO OF GMJJOAOUIN COUNTY PUBLIC HEALTH smviIC,EB,ENVWIDDNNMj7EN'TK/MALIN DIVISION. <br /> JOB AUUMAGIOR A'MNF A � � � I'd KOC 'LTC Ip- ip R n/��C,IITY-�}.�-n-/ �L L_/`- COT BfZE <br /> OWNER'S NAME�O[ AGGRESS //2p '462-/E/!G/'L E- t — <br /> CONTRACTOR /�— � G AMbRE66 �O�[,44uf LICSA pwt* e I��rS Zt? / <br /> SUN CONTRACTOR ADORK80 UCF PHONE <br /> TYPE OF SEPTIC WORK: NEW INBIALLGTION Q RPASUADOITION OEATRUcTION❑ <br /> IND SEPTIC SYSTEM PERMITTED IF PUOUC 8rMR IB AVAILABLE WITHIN 200 FEET OF BUILDNI40,1 7O1C IYTNR I 1 NOW MANY <br /> ApSSaSSeR/_ <br /> INSTALLATION WILL S61VL RESIDENCE V COMMERCIAL❑ OTHER❑ <br /> M.AIDER OF UTAWO UMTS: / NUAMSM OF SEOMOMS: 4 IAIMBEI Of SMPLOYEES: <br /> CHARACTER OF$00.TO A DEPTH OF O FEET: PITMUMP BOIL CHARACTEII // WATER TABLE DEPTH <br /> 9E7TO TANKROIIEASE TRAP ❑raw waPmt— CAPACITY IJs/ NO.COMPARTMENTS <br /> WO TRLA <br /> TREATMENT PLANT❑ DISTANCE TO NERPI <br /> AT; WELL FOUNOATgN—� PROPERTY LIRA /�r <br /> UFT IIIATiON❑FSIZE TYPE OF PIMP BAHO OIL SEPARATOR ENCLOSED OYSTEMI T <br /> SI <br /> LIACMNO LINE t NO.l UNOTH OF LaKa— 1 7� ..FA.CE TO NEAR,_,WELLc POUNT'.ATgN PROPERTY <br /> FILTER Bm ❑VMOTH LENGTH_ DEPTH DIRANCE TO NEAREST:WELL POWNDATON PROPERTY LINE <br /> MOUNDED El WIDTH LENGTH _DEPTH OSTANCE TO HEAREST:WELL ��FCMNOATION PROPERTY LINE <br /> SEIPAOE FRS DEPTH .S7h slzE �_NULMER�_DISTANCE TO NEARST:WE L��i FOUNOATq�lQ/ FROPORY <br /> SUMPS ❑WROTH LENGTH _DEPTH DISTANCE TO WAAEST:WELL _FOUNDATION PROPERTY LINE <br /> DISPOSAL POROS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL__FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL SE DONE IN ACCORDANCE WITH SAW JOAOUIN COUNTY ORDINANCES AND STATE LAWS.MID RULER <br /> ANDREOULATIONS OFTMSANJOAONNCOUNTY.HOME QWPMAORL/CIEKWEDAGENT'S WONATTNE CERTIFIESTNE PMLO'AWG:'I CWTFYTHAT INIM PERFORMANCE OF THE WORK FORNISCH 1%} <br /> THI8 PERMIT I/ISSUED,1 SHALL NOT EMPLOY ANY PERSON M E <br /> SUCH A MATTER AN TO BECOME SUBJECT TO WORKUMIrl COMPENSATIONIN <br /> LAWS OF CALIFORNIA.'CONTRACTOR'S HIRING OR <br /> 8U=NTHACTINO MWATURRE CENTRED THE FOLLOWING'I CERTIFY THAT IN THE PERFORMANCE OF THE WOMC FCR WHICH THIS PERMIT It ISIUEO,1 MALL EMPLOY PERSONS SUBJECT TO <br /> WOIKMNYS COMPENSATION LAWS OF CALLRORMA.' THE APPLICA <br /> N <br /> T <br /> MUST CALL N HOLM W ADVANCE FOR Ali MGI'.AIgP[CRONS. Cos"'E OI"m FLOW. <br /> SIGNED X t f,�= OL !0 Y / <br /> TT ml�; DATE: X <br /> PLOT PLAN DRAW To$CAiEI KALE IA W <br /> I.NAMES OF STPEETI OR ROADS NEAREST TO OR SOUNDIWI THE PROPERTY. R.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PFVNKYKD <br /> 2.OUTLINE OF THE PROPERTY,WIN DIMENSIONS AND NORTH DIRECTION. FXPANSON OF SEWAGE OIIP08AL ARMS. <br /> 8. DIMENSIONEIN <br /> D OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, E. LOCATION OF WELLS WUHIN RAW$OF ONRE <br /> E HUNDRED FIFTY FT.ON <br /> XVCLUDINO COVERED MEAS MICA AN PATIOS.DRIVEWAYS,AND WANK@, THE PROPERTY DR ADJOIQKG PROPERTY. <br /> ... <br /> ..............:. .Y..G/S,Sir ..... .... ... <br /> .. <br /> ....................... r .y. .... .. .... .... <br /> O ....... ..... ...... <br /> . ... ..... <br /> c <br /> ........: . <br /> ......a.....;.................. .....:... ..... <br /> I�JS. <br /> ..............:. ......... <br /> . ...........€....:.. . .... .. <br /> ....'..........i..... ..... <br /> . ........... . .......... <br /> . ../x^30�.... .....�. <br /> ......:. ...:..... ............:.....:.....:.....: <br /> rr: <br /> i...... ........... ....:....:...........:. .... :................ <br /> , <br /> p...... . ..:.. : .... .. <br /> ..i.... ;. ... .....+.. .'.......... ........ . <br /> ...>.... .. <br /> : <br /> ...E... <br /> .......; ...:.. ASG1T6ANR1 <br /> M,I'GSEC7N)1A.M'Ttii:•.".E':.CN!N47,=US.�:E:)Ylam <br /> t1f{...:....:.. ..... ....... <br /> PON OOARTM6R IME ONLY <br /> APPLICATION ACCEPTED By DATE: ARTA: <br /> TAIL,Fn OR SUMP MSr*=M IIIY OATS / / FINAL INSPECTION Y DATI, ( II 1. <br /> AOOT)ONA.COMMENTS: 1 - <br /> ACCOLNITV40 ONLY; ALOE FAC! <br /> -JAS A <br /> PI COON P6 INFO AMOUNT MINIFIED CIIEC KASH RWEVED IV DATE SR f PAST NUMBER NeVO P <br /> ea ' 17/ 1 <br /> Pub.Heanh Serv.-Eneiro.174 13196) <br />