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APPLICATION FOR LIQUID WASTE PERMIT
<br /> SAM JOAQUIN COUNTY PUBLIC HEALTH SERVICES
<br /> ENVIRONMENTAL HEALTH DIVISION
<br /> 11 a P.O. BOX 388, 446 N. SAlll JOAQUiN ST., STOCKTON, CA 96201-0388
<br /> i(209� 468-3420
<br /> ROS!-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATF ISSUED
<br /> (Complete in TOpliicste)
<br /> APPI-1CATIUN IS HEREBY MAUI=TO THE SAN JOAOItIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTAU THE WORK DESCRIBTD. TINS APPLICATION 16 MADE IN COMPLIANCE WITH SAN
<br /> JOAOVIN COUNTY DEVFLOPMFNT TH LE,CHAFTEn 9-1110.3 AND THE SrANDAROS OF SAN JOAOUIN COUNTY PUBLIC HEALFH L-ERVICES,ENVIRONMENTAL HEALTH DIVISION.
<br /> JOB ADDRESSIOn Af'4dR._&6 Z �✓, LOT SIZE _
<br /> OWNER'S NAME ,ry ADDAESS PF-LONE 4 i �j
<br /> CDNT RACTOR y� �f- .�.. 1 r _ADORES9�ff (�� aJ �1^r�i / LICl' _P41ONE / Y'IRpi/}7,�
<br /> $013CONTRACTORr��1,(( '" L�AODnEBS:7C1 `l• /`7`d LFCR
<br /> TYPE OF 4EPTIC WORK: NEW INSTALLATION —At")AWAVON ❑ DESTRUCTION L.] f.....
<br /> tt1O 3Y5fEM PEHMTTTEV IF PUCIUC SEWER IS AVAILABLE WITHIN 2m FEET OF BUILDING.} PERC TEST(+(I I NOW MANY
<br /> INSTALLATION WILL SERVE: RESIDENCE*COMMERCIAL ❑ 3 OTHER ❑ / . % ,
<br /> �
<br /> NUFARM OF LIVING UNI FS: NUMBER OF BEDROOM& -......,»..,.._...-. NUMPEII OF FMNM,OYEEB: f`1"�1
<br /> CHARACTER iO SOIL T A DEPTH OFF 3 FEET:= ---Flfl 4P�SOII&CA ACETY__/� 00 @Az- TABLE DEPT H
<br /> NO.COMPARTMENTS__
<br /> SEPTIC TANKIOREASE TRAP U TYf'EIMFG_ N S�je—Q rP ! .J,...� / r,�
<br /> M`.G'1"REATMENT PLANT 11 DISTANCE TO NEARrST: WFI.L foo-P _ FOUNDATION !D '/ . FROP£PTY UNErz—t-1/-
<br /> LIFT STATION C.J SIZE __'TYPE OF 11.1 _ SAND OIL FEPARATOR{ENCLOSED SYSTEM) J
<br /> LFACFMNO LINE ❑ NO.L,LENGTH OF LINES 0 -!+ DISTANCE TO NFARER"r:WFLL ___y I FOUIJDATION ed �f'f10F 7T1Y LINE
<br /> FII 1M HEp ❑1MIO TH LENGTH _DEPT II_ DISTANCE TO NFA.RFST:WFI L FOUNDATION_ I"'.0PERTY I.NIE_
<br /> MOUNDED fL�1A'fT)fI IPNGTH OFPTH DISI ANCF TO WARE ST:N1TLL FOUNDATION. DITOPFlUY LINE
<br /> 6FEPAGw PITA L7 OEf'TLISIZF, 'Iy.__ _. Nl1MBER .1.1-AWE TO NEARF,6T:WF1,11KETOUNpAT10,"1��� f'[IOF'£C[T'Y LINE��
<br /> RV*!Pn ©e1lol it _tfNO r _ur.mH _DISI ANC TO NEAREST:WELL__ FOUNDA I ION__ PPOPEMY LINE
<br /> DISPOSAL PONDS U Vt'IpTN_. LENGfH_--UEPfH DISTANCE TO NEAREST:WELL. FOUNUAIFOfJ FILOT`ERfY LINE .�
<br /> I 1'TT'I:FSY CERTIFY TT(AT i HAVE PRF PARFU THIu AfFl ICISION AI•ICl 134AC THE WUFiF[Wit SF C`OHF'iJ ACr-pnUA�ICE WIT It flAN.LOAOU3N COUNT?OTPtNgN[;£^AND S1ATE IRWS,AND RULES
<br /> AIlnFEe;ULAf1ONS OFTFIE SAN JOAO9IN COIINTV-I;Ot.`COWN(P Ona)4;rNSFS)AU(NT'S.",I0I)ATLFnr CERTIf$[n 1'HE FOSAOLVIFTG:'IrEF11Ffr'THAT'."1THE PERLOn LANCE OF TITWOrr.FOF1%IIICH
<br /> Tws PTnmir IS lr^41ED.1 g!!^-L_L WnT EMr LOY ANY FERS')N W'-UCH A FAANWA AS In IACOCO:SVP-IFCT 10 WOPRIAAWS COC!f'F.NSAIW71 LAWS OF CALIFORNIA.- CONTVSAr TOR'r HIRINO OR
<br /> 6l11 CONIR.ACTINO SI(J#ATURE.1:1 Ill!rlF.r THE FULLOWINU:'1 CFR(IF'r FHA-F IN TI IE Pf.RFDNMANCE OF Tim kwFw FO11 WH1^VI THIS 1`LM-!1 Ir ISSUED,1 rilM 1,FVPt OY FTRSONR SUBJECT IO Q..—
<br /> WfjW,,F,fAN-S COMPFUSATI'7N LAWS OF"MFIWA,- THE APPLICANT MUST CAE'..24 IIUURS IN ADVANCE FOR ALL REOUIREO INSPECNONS. COMPLEIF DRAWING MADW.
<br /> SIOliEO x [A�-�" � - - - _TITLE: OATE:_z:_ —1 =>
<br /> PLOT PLAN 11'},AW TO SCAT-E}SCALE "10
<br /> 1. FWAFS OF SIRF..FTS OD ROADS NFARFgl'TO OR POUriniw.THE I'ROPFRTY, 4, LOCATION OF HOUfr.RFWAGF f)1f O6Al.SY6TEM OR PVklPO:ED
<br /> 2. C'IFTLINF OF TNF PRo^FnTY,tMlt1 ANG N1,11111 IAKCTICFI, Erl'i'JISWN OF 3TI1''1;E DlTPO6AL 9w8IEN o.
<br /> 3. IffAFN^!ONfti OUT#INF6,4N11 L(W,ATION OF ALL FKi3 f iriG AND PW)POSEO SIRUCTUVES, S. LO^.7;rtnsl 7F YNFlL^.•\NfT 13[tJ a.+Ul!.1F OF Oh;E HUF1pnEU FIFT'!TT.OII
<br /> S1CU10lNG CnvE1;hV ASLLAS:INCH AS f Al Ip S,Dlt}11F.'d,FAY G,APID h'hL Y.4. THE FY'f)PFDTY On Ai1J0fT!INf,ITOFTRTY.
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<br /> PAYMr+ r MI ..
<br /> RECEIVES
<br /> {3
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<br /> JUL1 8 1905 . ��
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<br /> SAN JOAQUIN COUNTY
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<br /> I PUBLIC(-IEAL1 i 1 Sil1�,,,?,
<br /> EN1�1 tf�i T�[L( , L UIVI ION + . I
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<br /> Afil'LICAiION ACCEPTED �J �� 7,�.-�.�.,1�-�_ pnTE: � ` � AFiEA:
<br /> lAEIY.,TTT OR Sump IFI^PFt PION BY DAfE ! ! TIkAL INUF'ECT ION BY ✓C4` L _DATES` ! - !
<br /> AUOTI IONAL CDF'-'f,t31 S: _. k_ ' .
<br /> ACCOU`IINO ONLY: At r TACd
<br /> M CODE�� FEE`INro AMOUN L RENIFTTFJJ ~CHEGY.SIC 611 RECEIVED BY DATE M 1 F'flVAIT NUMM1E31 INVOICE R
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