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APPLICATION FOR LtaUIO WASTE PERMIT <br /> SAN JOAaUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,446 N.SAN JOAOUIN ST.,STOCKTON,CA 95201-0380 <br /> )202)465.3420 <br /> NDN-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> MamplaEe M Trl/IknW) <br /> APPUCAT;ON IS HEREBY MADE TO THE SAN JOAOUN COUNTY FOR A PERMIT TO CONSTRUCT ANWOR INSTALL THE WOFK DESCRIBED.THIS APPLICATION IS MADE IN COMMMCE,M HUM <br /> JOAOUN COUNTY DEVELOPMENT TILLS,CHAPTER S-1110.3 AND THE STANDARDWOF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH OMSION. <br /> P <br /> Joe ADORE ssAq � I Ar LOT B� <br /> ONExB HAME1AoprE55���� V� ]N PNDNE <br /> E�.-�� N✓ as �j/-/��n <br /> COMnacrOfl_j_�[ .i2 r AO011E5E jcr YLn .o UCp d'7484,P—wt. or., <br /> S—CONTRACTOR ADDRESS LIC! PHONE <br /> TYPE OF SiPTIC WORK: NEW INSTALLATION REPAIPJADDITION❑ DESTRUCTION❑ <br /> ONO SEPTIC SYSTEM PFMTR L IF MBUC SEY,TR IS AVAILABLE WITHIN 200 FEET OF BUILDIRRG.I PEND TFDTHI[1 HO'N MARY <br /> INSTALLATION VALL SERVE RESID7ICE I& COMMERCIAL❑ OTHER❑ <br /> NLMBER OF LMNO UNITS:_/ NUMBER OF GmR100MS: NUMBER OF <br /> EAROYIiI: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: /PITlS MP SO7 CHAPACTER; / WATER TABLE DEPTH <br /> SEPTIC TMINSRP ax TRAP lz 'MrO C',.I C•i e%T'F CAPACITY L[n C7U NO.COMPARTTIENTi L <br /> PALO TII[ATMWT RAM❑ OLL7ANOE TO NEMKT: WELL FOUNDATION rROPERTY LINE <br /> LFT STATION[3 S= <br /> Tr9E OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEML _ <br /> LEACHINGUNE i7 NO.k LENGTH OF UNE.S '^ b��/ DISTANCE TO NEAREST:WELL—ir'2"FOUNDATION PROPERTY UO <br /> NE � <br /> FNL� <br /> TSIED ��'❑\\\1�TH LENGTH DEPTHDISTANCE TO NEAREST: LY LI <br /> WELL FOUNDATION PROPERLY `^l <br /> MOUN0® ❑WIDTH (� IFNOTH rr DEPTH DISTANCE TO NEAREST:WELLWI:NOATION G� PROPERTY UNE O <br /> SWAGE NTS X DEPTH �J / L. NUMSER--'L_DISTANCE TO NEAREST:WELL -{20 PJUNDATION J 0 pgPERTY UNE 5 / <br /> SUMS ❑YNDTN LENGTH__DEPTH DISTANCE TO NEAREST:WELL FOUNDATIONPROPERTY UNE <br /> DISp64A1 PONOS E3 WTITTH LENGTH DEFTI' DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APRICATIDN AND AT TH <br /> -ME WON(WNL BE PONE IN ACCORDANCE WITH SAN JOAOIIFN COUNTY ORDINANCES G STATE LAWS,µD RVLFe <br /> AND REGULATIONS OF THE 9M JOAOUIN COUNTY,HOME OWNER <br /> OR UCEANED AGENT'S SIGNATURERTIMS THE MUC WING:'I CERTIFYTHAT IN THE PERF ORNRK PO <br /> ANCE OF THE NOW WHI IS <br /> THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANCE <br /> NER AS TO BECOME SUSJECTTO MWMAN'S COMPENSATION LAWS OF CAUFORNA_•CONTRACTOH•S HIRING OR (O <br /> SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:•I CERTIFY I:MAT IN THE PERFORMANCE OF THE WOFK FOR WHICH THIS pFJtEUT IS ISSUED.I SHALL EMPLOY PERSONS RLWECT TO ^, <br /> WOFIMAN'S COMPENSATION LAWS OF CAUFpIWI/1.' T�`�`'AMT MUST CALL 24 HOURS IN ADVANCE FOR ALL REGUSIED NSPMTCNe.COMPLETE DRAWING BELOW- \' <br /> SIGNED x r S TITLE- .c{i J•r F r• 1 /(.7�9 <br /> Y — GATE:.�,[� <br /> l " <br /> PLOT PLAN(DRAW TO SCALER SCALE <br /> 1.NAMES Of STREETS Gq FIORDS NEAREST TO OR BOUNDING THE PROPERTY. 4.L13CATPON OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 4 -+ <br /> 2.OUTUNE O THE PROPERTY,VAIN DIMENSIONS ANO NORM DlECTIp N. EXPANSION OF SEWAGE OISPOf:AL BYSTF]Ie. <br /> 3.DIMENEONEO OUTLINES AND LOCATION OF ALL EXWMO ANO PROPOSED STRUCTURES, B.LOCATION OF WELLS WITHIN SAL S ST ONE HUNDRED FIFTY FT.ION <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALK&. THE PROPERTY OR LS WITHIN <br /> ADIOS N. <br /> M z <br /> PNT <br /> .. It? <br /> �•�` :.Fl1 .�CliE,�TyGii'Iti1 <br /> ... - R�.�1,jinn.� RF• <br /> • <br /> FOR DEPARTMENT USE ONLY —,Y•• <br /> APPLICATION ACCEPTEO BY DATE• Z„ <br /> AREA:_ f f <br /> TANG,PIT OR SUMP INSPECTION BY //I / DATE r I FINAL INSPECTION BY ATE <br /> ACOITIO,Nq+Y OMMEHiTB: (✓ {'i 'j• 1�� � � L: <br /> ACCOUNTING ONLY: AIDS FACE /w O <br /> PE C+O/DE FEEtINFD <br /> AMO-104T NUTTED 1CNH RECDVFD BY DAT[ SR(PERMIT 1IC�JLMMEOAI -I•� wvcxCEp <br />