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Fil <br /> I <br /> FAPPLICATION FOR LIOUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES �a <br /> ENVIRONMENTAL HEALTH DIVISION a������D <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> F (209)46&3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED I !V t <br /> ICamplI III Tripli-tel <br /> +I+I AFFUCATION IB HEREBY MADE TO THE BAN JOAQUIN COVHIY fOR A PERMIT TO CONSTRUCT ANDA.R ING,ALL THE WONT VF RSIEO.THIS APPLICATION 18 MADE IN COMPLIANCE WITH SAN <br /> k <br /> ARDS OF SAH JOAQUIN <br /> JOAOUIN COUNTY DEVELOPMENT TITLE,CH E-1110.3 AND THE STJOAQUIN COUNTY PUBLIC H[ALTH E <br /> SRVICE&ENVIiq"EPIPIAL HEALTH PINBIOH. II`411j% <br /> Il �f 1OA APFII � CRY <br /> JOB AOORE68LOF 612E <br /> I } {T <br /> r <br /> PlIDNE <br /> OWHEA'S NAME �-�-� y ,w'Y • ADDRESS ,/ �� ""`i.J'•�+ �,n <br /> r{ <br /> ADDRESS <br /> COHTAACTOR mg PHONE <br /> IDCF PNONF <br /> SVS CONTRACTOR ADDRESS <br /> '- TYPE OF SFPTM WORE: NEW INSTALLATION 11 REPAWAODITION❑ bFSTAUGTOX❑'i <br /> j <br /> IRO SEPTIC SYSTEM PEHMRTm IF PUBLIC SEINER IS AVAILABLE WITHIN 200 FEET OF BUILDINO.1 P91O TESTM l I NOW MART— <br /> INSTALLATION WILL S9SVE A////EBIOENCE'� CPMMEACiAL Q OTHER❑ //JJ�L <br /> MUI.ISFA fW tJy[No UMTd:��NfA'NSER OF.—ODMS: NUMBER OF ENPLOYEES:-„}.L_ <br /> WATER TABLE IDEPFH <br /> CSIMACTER OF SOIL TO A DEPTH OF 3 FEET: �l61TMP SOIL CHARACTER: <br /> �y ��.y 1 NO.COMPARTMENTS � <br /> +FOLIC TANEIOREASE TRAP L.i-EYF'EMIFD F^.' J�i_^l�'l`_[�'GMACRY . <br /> PEO TREATMENT RA11--N--1T1❑ DISTANCE TO NEAREST: WFLL�_ W VNDATION LTIDPLTTTY LINE <br /> LIFT STATION L BILE TYPE OF PIMP RANO OIL SEPARATOR IENCLOSED SYSTEM' <br /> ,,EFS� ul n[y WELL FOUNDATION is __P,C,FERTYUNE <br /> LEACNNO UNE Ya.NO.d LENGTH OF LINLB "'^'� DISTANCE TO NEAREST: J� <br /> RETIRE am ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST!WELL FOUNDATION PROT'ERTYUNE <br /> MOUNDED ❑WIDTH LENGTH DEPRI METANCE TO NEAREST:WELL FOUNDATION PR IPERFY LINE <br /> SEEPAGE PITS 13 C, SQE NUMBER DISTANCE TI!REALES[:-LL <br /> FOUNDATION PROPERTY UNE <br /> SUMPS ❑WIDTH LENGTH DEPT" DISTANCE TO NEAREST:WEU­__,­FOUHPATIDN <br /> PROPTI UNE <br /> �1 <br /> pISPOSAL►ONp+ WIDTH_LENGTH DEPTH DISTANCETO NEAREST:WELL FOUNDATION FRpPERTYUNE <br /> _ ❑ <br /> 1 HfREBY CERFIFY TNT I HAVE PREPARED THIS APPLICATION AND THAT THE WPW WILL BE DONE INACCORDANCE V T BAN JDAWIN COVNTY OPWNANCES AND STATE LAWS,AND RULES <br /> CH <br /> AND REGUTATlDRA OFTHE SAN JDAOIIIN COUNTY.HGME OWNER ORLICENBED ADENT'S SIONAWRE CERTIFIEBTNLFOLLOVYINO:'1 CFRTIFYTHAF{NINE PETIH,RNIANCE OFTRACTO R lFHIRING O <br /> ` THIS PERMIT ISS ,1 SHALL NOT EMPLOY ANY PERSON H A MANNER AS TO BECOME WWECI TO WORKMAMS COMPEIIBATION LAWS OF CALIFpAL EM L O KFISON LYS HIRING OR <br /> SVBCONT O NATURE CEK"FIEB THE FOLLOWING '1 CE FY THAT IN THE PEWORMANCE OF THE WDW FOR WHICHTHIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SIIBJELT TO <br /> WDRKMAH'B M SATION LAWS OF CAUPORNIAL'TH APPU ANT MUST CALL 14 HOUHS IN ADVANCE FOR ALL REOWT INSPECTION+,COMPETE DRAWINO BET4W. <br /> ' SIGNED% - .- TITTLE: <br /> Ir PLOT RAN WRAW TO SCALE)SCALE_'- ' <br /> T: 1.NAME OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4,LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PLGPOSED <br /> IH^I Z, S. <br /> OUTI-INF OFTNE RIOPERTY.WITH DIMENSIONS AND NOIR"DIRECTION. FUD AN ION00 OF SEWAGE OIm'OSAL SYBTEON <br /> 3.DIMENSIONED OUTLINES AND LOCATION OF ALL EIGVEINS AND PIOPO6m STRVCTURE6, S.LOCATION OE WELLS WITHIN RAOS18 OF ONE HUNDRED FIFTY FT.ON <br /> + INCLUPINO COVERED AREAS SUCH AS PATIOS.DmVEWAYS,AND WALKS. THE PIYIPERY OR ADJOINING PPgPERTY <br /> �i .,..... :... ...r. _ <br /> I' . [� ... ............. <br /> -.. <br /> ........... <br /> ..r.... -...-...,,. _ o. ....,... a....... ... ...... <br /> ....... - - <br /> ..... <br /> ...... <br /> t <br /> . ............ <br /> ............ <br /> k <br /> .....„....- - <br /> .......- <br /> E <br /> f\ S {rte w <br /> ...........-- <br /> .............. <br /> ...... ............ <br /> .......... <br /> :.. .,,. I �T i. <br /> ......... <br /> Y 0.: py;. .......... <br /> ...... zz�L . <br /> ............. <br /> .......... <br /> ¢.. ... <br /> .......... <br /> T <br /> ..;.. L ,. <br /> SADi.10tN'CCJLIFIT7' <br /> ......PUBNO Fj'CIO,LTH SRIFy19E5- ..�.......t.;.....,. ...- --.., .,. - .o- Y <br /> I _ .°...ENVVf�ONA'iEfJ7ALHEP.LTH'DIVISION <br /> Fr -AR DEPARTMENT USE ONLY <br /> AREA: <br /> APPLICATION ACCEPTED BY - _ <br /> DATE I ! .HNALL INSTECTION BY pATf 31 ",+ <br /> TANK,PIT PH SUMP INSPECTION BY I <br /> ADDITIONAL COMMENTS: <br /> 8p-.q o <br /> ACCOUNTING ONLY: AIDE FACT <br /> ZI <br /> PE�C7ODE FEE INFO AMOUNT REWITED RLC CASH ITEC HY DATE SIR/PTAMI,XLILrB9i INVOICES <br /> L <br /> Pub.Health SONY.-En**-174(M6) <br />