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APPLICATION FOR LIQUID YVASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOR-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> MompoIBtI In TI}Delel <br /> APPUCATION M HERESY MADE TO THE SAN JOAQUIN COUNTY FOR A MEAT TO CONSTRUCT ANDJOR INSTALL THE WORK DESCRIBED. THIS APPLICATION 10 MADE IN COMPL11NCE WITH BAN <br /> JOAQUIN!COUNITY DELELO"AENr TITLE,CHAPTER 9-1110.3 AND THE STANDARD@ OF BAN JOAOUNN COUNTY mimic"mrN SERYKES.EfIVNOwujTAL HEALTH OMBON. <br /> JOO ADDRESSOR APW C. PeAk,r CITY, ] lar er2E .,�C� <br /> -ElOYJNEII'S NAM[ ADDRESS_ SPO A&S,�- _pFgF1E.7r�1 o I Z <br /> /y� / " po fox G5 n, LICE rlgS RpN�a�s-7 T13 <br /> CON1wACTO11_ I!l KQ.. YL II�r AOOnEB. <br /> BU@CONrFNCTOR ADDRESS ice "NE <br /> TV"OF SEPTIC WORK: NEW MSS ALLATON❑ REPAIVADITON Le OSSTMJCIION❑ <br /> IMO SEPTIC SYSTEM PERMITTED IF MJNJC SEWER le AVAKAME WTTHM TOO FEET OF SUEDINO.) )NRC TSRIN[I M w MANY <br /> — APPSAMsn F_ <br /> NNSTAlLAt10N 01S <br /> WILL SO : RESIDENCE 1L/COMMERCIAL❑ OTHER❑ <br /> NUBEFA OF LIVING UNITS: IRlIM9O1 OF SEDRDOMS:�_NUM06K OF EMPLOYSSS: <br /> CHARACTER OF @OE TO A DEPTH OF 3 FEET:-15-A (Y pTISUMP EENL CRARACTER: -5 C W WATER TABLE DEPTH_ <br /> SEPTIC TANKIONEA@[TRAP ❑TYPfAAFG FAPACITY NO.COMPARTMENTS <br /> PES TREATMENT PLANT❑ DISTANCE TO NEAWST: WELL 21 FWNVATON PROPERTY LINE <br /> LIFT STATION❑ NMF TYPE OF PUMP SAND OIL SEPARAIOR ENCLOSED SY8TEMR J <br /> r ! <br /> IEACHMO UNE P�1r0.a LENGTH OF LREe_ 4 —110 1`4A I,}{%(.,f` 01HTANCE TO NEAFE A:WFLL��_FOUND,ITON�_PPpPERI'Y LME- Q�J <br /> FETm1 SED ❑WIDTH LETNOrH DEPTH OIBTANCE TO NEARER;WO­L_IOLNIDATON PROPERTY LINE <br /> MOUNDED ❑WERH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNOATION PROPERTY 111E <br /> A®AO[PITS p1M 1_jS /4ENI 1. I DNMANCE TO NEAIET.wELL-��'[�'.UNCATSDND RNPREITIY UNE <br /> SUM" ❑WIDTH LEHOTH —DEPTH DISTANCE TO NEAREST:WELL _FOUNDATION PROPERTY LINE <br /> OIAPOBK PONOS O WIDTH LENGTH bEPTH DISTANCE TO/EAIEUT:WELL FOUNDATION PROPERTY LINE <br /> 1 REROlY CERTIFY THAT I NAVE PREPARED THIS AP ATON AND THAT THE WORK WILL M DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANGES AND STATE LAWS,AND RULE; <br /> AND REOULATIOH@ OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT-8 SIGNATURE CERTIFIES THE FOLLOVANO:-1 COMFYTHAT INTHE PE/womm CE OP THE WOPIC FOR W"CN <br /> THIS FEROAT LS MWED,I SMALL NOT FIEPLOY ANY PERSON M OWN A MANNER AS TO WCOME KMACT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.* CONTRACTORS MIRING OR <br /> SYS-CONTRACTING SIGNATURE CERTTRES THE FOLLOWING:'1 CERTIFY THAT M THE"MORMANCE OF THE WORK FOR WMKH TIM PO%Mrr IS I@MED,I WALL EMPLOY PERSONS SUBJECT TO <br /> W OAKMAFN'S COMPENSATMN LAWS Of CHJMjRJ,f1NIIA.- THE A"W ANT M1Al-CALL!s HIMM IN ADVANCE FOR AIL,NSOUIRSD NBp/RT10NG.COMPLETE DRAWING KLOW.! <br /> SK"D R u,(Elf�{/`�`--� Trnu V! / 1 9 QST nr DATE:`LS `� <br /> ���TTTTT PLOT PLAN OMW TO SCALE)SCALE_ _ <br /> 1. NAME[OF OTFWFT OR ROADO NEAREST TO OR mIU NG THE PMDKRT'Y. A.LOCATION OF LOOSE SEWAGE DIMOSAL SYSTEM ON PROPOSED <br /> 7.OUTINE OF THE PROPERTY,WITH OIMENIONS AND NORTH DIRECTION. EXPANSION OF SEWAOE 04WOBAL SYSTEMS. <br /> ]. DIMENSIONED OUTLINES AND LOCATION Of!ALL EXISTING AND PROPOSED STRLICTNIE►. S.LOCATION OF WELLS WTI)RADIUS Of ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COWED MEAS SUCH AS PATIOS.ORIVEWAYG.AND WARS. THE PROPERTY OR ADJOMM FROFIREY. <br /> ...... ..... .. .. .. .� ... <br /> . ....... <br /> .A/ y <br /> .. <br /> " <br /> �PlICtAtPE�1�' � .: .... . ... \ <br /> /R <br /> .... <br /> .. . .. <br /> y-: i........._I .......... . .. ...... <br /> r.. 1 <br /> s.. . :. <br /> .... . <br /> .. . A <br /> ...._. .... ... .�--�7 E . _ ...... :... - .. .. y <br /> ... .. am.. .. <br /> ...... .:....:.... . ....:.... <br /> r <br /> E r ... <br /> ......... .............................� ................ ............ ... ... ' ... r ... . <br /> t �iHUNAriENTh1 H ~ (:ES <br /> OLPA�/Iw[ONLY EALTI,LNJISII.R <br /> APPLICATION ACCEPTED SY FOR RTMENT R/ `— r� 4 6 (R� AREA:2� <br /> TRIC.PR OR SUMP MSPEC71ONjSY DATE <br /> � FINAL INSPEECLTIIONN by DATE_ I I <br /> ADDITIONAL COMNIVAS: LJ�'L7\ 1 CLW- 5 N��-�r—A <br /> ACCOVNTFA ONIr: ADE FRCP <br /> FE CO'JE PEE SNO AMOUNT ROUTED OICA;N RECUVW at DATE M I POINT NUW9Wt MVOK[ <br /> 4-L11- 1 ``-lf <br /> Pub.Health Sen.-Enwro-174(3/98) <br />