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APPLICAFI-INFOR LIQUID WASTE PERMIT <br /> SAN•JOAQUII, ANTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,445 N.SAN JOAOUIN ST., STOCKTON,CA 95201-0388 <br /> {209]468.3420 <br /> Ff KBN-REFUHDABLE PERMIT EXPIRES I YEAR FROM BATE ISSUED <br /> ICGmpists in TTgGEaW <br /> APPLICATION IS HERESY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALLTHE WORK DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> CAGUIN COUNTY DEVELOPMENT TITLE...CHAPTER 9-1110.,r3/,,��AND THE STANDARDS OF SAN JOAQ{UIINN COUNTY PUBLIC HEALTH SEEM}CES,ENVIRONMENTAL HEALTH DMSION. ^ G <br /> B ADORESSWR APNN !]J _ f]I ��'��1��t� i(1 - 1R.�N�_CIFY �Lb� '1� - LLOOTdSIl V�2O /� ADDRESS •c PHONE 2 J y""/7 3+J <br /> OWNER'S NAME.N1�1 f1/ �L IJ� I LICs � J.,L <br /> ^ NTRACTOR 1 L 1W �'u�L`P� ADDRESS b 613 lF PHONE <br /> JB CONTRACTOR ADDRESS <br /> I" PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIRIAODITION ❑ DESTRUCTION❑ <br /> IRO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) pMC TESTNI 1 I NOW MANY <br /> i Apdieel"! <br /> ,4 INSTALLATION WILL SERVE: RESIDENCE U/COMMERCIAL❑ OTHER❑ <br /> NUMBER OF LIVING UNITS: NUMBER OF REDROW": NUMBER OF EMPLOYEEEnII: <br /> CHARACTER OF SOILTO A DEPTH OF�33 FEET: r.A�T cPfTISUMP SOIL CHARACTER:]GnWATER TABLE DEPTH <br /> YNc TANKIGREASE TRAP VJ r1w1mFG L __CAPACrrV ^f R R,_NO.COMPARTMENTS? <br /> La TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> UFT STATION f'STINZ TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACHING LINE y. AO.A LENGTH OF LINES�1 �' DISTANCE TO NEAREST:WELL FOUNDATION �PROPERTY LINE <br /> FTEFI:: ❑WIDTH LENGTH DEFTHDISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINEUN ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFDUNDATkON PROPERTY LINE <br /> .��PITS ❑DEPTH _ S2E � NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> SUMPS I1•WIDTN_�_LENGTN�,,,pEPTR _DISTANGETG NEAREST:WELL„ L40 FOUNDATION, `tea PROPERTY LINE—�— . <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PIDPERTY LINE E <br /> 1ETIEBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WELL BE DONE IN ACCORDANCE WITH SAN JGAOUIN COUNTY ORDINANCES AND STATE LAWS.AND RULER <br /> _ JD REGULATIONS OF THE <br /> SAN JOAWIN COUNTY.HOMEOWNERORLICENSED AGENT'S SIGNATURE CERTIRESTHE FOLLOVANG:N CERTIFYTHAT INTREPERFORMANCEOFTHEWOFK FORWMICH <br /> R c <br /> THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUB ECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORMA.' CONTRACTOR'S HLRING O <br /> SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWLNG:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL MVLOY PERSONS SUBJEGY TG t <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED LNSMTIONa. COMPLETE DRAWING B I <br /> C <br /> f <br /> TRLE: L+''T51�'T�g4'1'D� DATE: �� I <br /> y.^,HED% y..•�,,.R. — _ <br /> dI <br /> PLAT PLAN(DRAW TO SCALE)SCALE 'to <br /> NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NOT"DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> L DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION OF We"WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> T INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> .. _.. .. ....... .......,. <br /> * I . � <br /> _ ., <br /> . X11 <br /> I �. . ....... <br /> 1 <br /> Nva <br /> Q. ..... <br /> ° �o� <br /> /p <br /> _ ..... .. ...:::::. .rt .:.: .o .... L!L <br /> n�a6 <br /> so <br /> PAM F" <br /> .. .. ... . <br /> ... <br /> tP`� <br /> L <br /> I A <br /> �Y <br /> k <br /> � 1 <br />