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L1CAF�H FOR LIQUID WASTE PERMIT <br /> SAN aU- 'JUNTY PUBLIC HEALTH SERVICES C � — <br /> ' ENVIRUNMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> 1108 UVIIUA LE PERIWE EXPIRES 1 YEAR FROM DATE ISSUED <br /> I Yt.In Tr ReStt <br /> � IP 1 <br /> APPIICATKM 10 HEREBY MADE TO THE BAN JOAOIIIN COUNTY FOR A PERMIT TO CONSTRUCT ANDMA INSTALL THE WO(K M=MBFD.TILS APPLICATION b MADE IN COMPLIANCE WITH BAN <br /> ;)B <br /> OVMCOUNTY DEVELOPMENT TIT CHAPTER S-i i 1 .b AN TF E BT OF IAN NOAOUM COUNTY PUBLIC HEALTH SERVICER. VIIIOMIAMAL NEALTH DMSION. <br /> ADDRE68/0R API/ <br /> 3 L CITY LOT SIZE <br /> FWMM-9 NAME IV114 ADDREBB ATONE <br /> CONTRACTOR i �F,�/,(r..//���fle , ADORESS / L' /G�A /,� �'+`-GF/'L� LOCI <br /> PJ.VO CONTNACTUR n-ro 4,• AODREBS I�/ C- C.I1.•V1 cS .%r'AL..(ICF PHOR <br /> YRE OF SEPTIC WORK: NEW INSTALJITIO REPABUADDITION❑ DESTRUCTION❑ <br /> GIO SEPTI[SYSTEM FF47RL111'fED U PUBLIC EkVPER IB AVAILAR E ThIfT111N 30D FEET OF BUILDING P61D TESThI l 1 NDW MAN7 <br /> tTAMA71OR WILL FDIVE: REBIOENCE❑ COMMERCIAL❑ OTHER E3 <br /> IIAYmq DF WINE UMTS: NUMBER OF S MS: NUMBER OF D1IPLDYEES: <br /> �OR SOR TO A DEPTH OF 3 FEET: PIT18tILIP C WATER TABLE DEPTH <br /> IIORFAeE TRAP ❑TYPEIIAFO CAPACITY lo7d— NO.COMPARnAEWS a <br /> D TREATMINIT SLANT❑ DISTANCE TO NFApEtT: WELL FOUNDATION PROPERTY UNE <br /> IIPT STATION❑ ARE TYPE OF PUMP��SAND OR SEPARATOR(ENCLOSED D1'ETEMI <br /> ERGINES LWF I•� NO.B LENGTH OF LINES I D .L:yl'L.t4' <br /> T DISTANCE TO NEAREST:WELL Z� r FOUNDATION �� f PROPENry LINE S/ <br /> -ALTER BED D WIDTH LENGTH DEPTH DISTANCE TO NEAREST!WELL FOUNDATION PROPERTY LINE <br /> MOUNDED �`Cqq],�NSDTH r1 —TH.-DEPTH DISTANCE TO NEAAEST:WELL FOUNDATION PROA:RTY IMF <br /> L.':27A—M PTS �EtbEPTH�c�• � (CNUMBER / DISTANCE TO NEAREST;WELL FOVNDAMON /CN PROPERTYLINEFScc0 WROTH IENGTII WSFANCE TD NF.MIEST:WEL FOUNDATION AOPERry WiEOtAI PONDS ❑WITH LENGTH DEPTH DISTANCE TO NEAPEM WELL FOUNDATION PROPERTY LINE <br /> 1 HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND Wall <br /> ZFMMGULA THEBAN JOAOUW COUNTY.NOME OWB$ga EO AGENT'S MONATURE CERTIFIES THE FOLLOWING:"I CERTIFYTHAT MTHEPERFO MANCE OFTNFWOW FORWHICH <br /> SHALL NOT EAO+IOY ANY PEABO}fJN'' NAMANNEiASTOBECOMEBUBJECTTOWORKMAN'SCOMPENSATIONLAYWOPCAUFOWBA.• CONTRACTOR'SHIPNOOR <br /> NG>DfiTURF ERTIFIES THE FO NG:•IWr C THAT IN THE PERFORMANCE OF THE WD1K FOR WHICH THIS PERMIT IS ISSUED.I BOWL EMPLOY PEMNB SUBJECT TO <br /> OAIPEN9A O IIA.• THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REOGRED INSPECTIONS.COMPLETE OMWINS BELOW.TITLE_ DATE: Ny£ PLOT PLAN 06W TO SCALEO SCALE OR FOADB NEAREBT TO OR SOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE tOPOM SYSTEM OR PROPOSED <br /> THE PROPERTY.WITH DIMENSIONS AND <br /> NORTH DIRECTION. EXPANSION OF SEWAGE OISPOSM 9YSTEA6. <br /> 3.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROFOGED STRUCTURES, E.LOCATION OF WELLS WITHIN RADNS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAE MUCH AS PATIOS.DWVEWAYB,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> .. ...;, <br /> .d ....3..,., .. .. '... 1 ... ; <br /> i ... .- .-E...-, .. <br /> QOM I' . <br /> I <br /> PAYMENT <br /> ., <br /> .. <br /> ;. <br /> RF=C. <br /> .AUG...: �. <br /> PUeLibAr LrsE°wc"Es „ <br /> :, ` <br /> ENVIIIONMENTpL FffALT3ial�{SIDN <br /> "...: <br /> � Top ENT uac oNLr <br /> APPLICATION ACCEPTED BY DATE: r �./ AREA' <br /> O /P7�11 BV7.IP MSPECTDII BY OAT D6 FINAL INSPECTION SY DATE I 1 <br /> yiMOF NAL COMMENTS! <br /> Tl66��i <br /> ACCOUNTMO O/RY: ADI FACY _ - <br /> i <br /> 1 PE CODE PFE INFO AMOUNT pfNILiTEG CI ASN RECEYFD■Y DA BN lPF3ihOT NISN861 INVOICE <br /> 2( ( 18r�.� aI <br /> PUD.HBNIIh 6arv.-EnvlrO.174(3196) ` <br />