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APPLICI,11'�FOR LIQUID WASTE PERMIT <br /> fff�I SAN JOAOUII`.,;OUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> �L (209)4&8-3420 <br /> ' NOR.REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 1CBmplstf FN Tripr"tsl <br /> APFl1CATION 18 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONOTRUCT AND/OR RISTALL THE WOW DESCRIBED.THIS AARJCATION IB MADE IN COM MANCE WITH SAM <br /> F,,11AGUIM COUNTY DEVLLDJPMENT TITLE.CHAPTER 9.1110.3 AND 7 STANDARDS OF SAN JOAGON COUNTY PUBLIC HEALTH SERVICES.ENV7RDNMENTAL HEALTHdVFS7N.0D LOT JOB ADDRESSIOR APN# <br /> OWNER'S NAME <br /> AbDRESS 4�M(Z. PHONE <br /> PHONE <br /> CONTRACTOR ADORERS <br /> � ADDRESS LIC# PHONEf SVB CONrEEACTOR ' <br /> _F TYPE of SEFM WORK: NEW ENOM <br /> STALLATN 0 REPRIADDITION PEsiRI1CTION❑ <br /> SO IIfPI1C 6YStEM PERMITTED k%16UC SEWER IS AVAILABLE WITHIN 200 FEET DFB HG,] <br /> pERC TESTITi i 1 HOW MANY <br /> — <br /> A <br /> A9P9oAlfon/ <br /> msTALLATRON%4SERVE: RESIDFNCE,U COMMERCIAL 0OTHER 11f NUMBER OF LMHO UNITS:—./­NUMBER OF BEDROOMS- NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOR TO A DEPTH OF 7 FEET: �A pRlSUMP 60ri ER:CHARACTWATER TABLE DEFTER <br /> SEPTIC TANXIORtABE TRAP OTYFVMFO CAPACITY NO.COMPARTMENTS <br /> PRO TREATMENT MA IT 0 DISTANCE 70 NEAREST: WELL FOUNDATION PROPERTY NNE <br /> 6IZE TYPE OF PUMP��SAND OIL SEPARATOR RNCLOSED SYSTEMS <br /> LIFT STATION 13 <br /> LEA61SN0 UNE IN <br /> 15 NO.A LENGTH OF IEB O DISIANCE TO NEARE#T:WELL <br /> WVNDATON PROPERTY UNE <br /> plT9t B@ t4 WIDTH�^LENGTHDEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> MOUNDED ❑N7EITH LENGTH <br /> DEPTH DISTANCETO NEAREST:WELL FDUNDAYION PROPERTY LINE <br /> SMAOE MTS ❑DEPTH SIZE HUMSER DISTANCE TO NEAREST:WELL FOUNPATIOH PROPERTY LINE <br /> a DEPTH <br /> DISTANCE TO NEAREST:WELL O <br /> FOUNDATM PROPERTY UNE <br /> SUMPS E3 WIDTH LENGTH <br /> DISPOSAL PONDS ❑WIDTH <br /> LLNOTH DEPTH DISTANCE TD NEAREST:WELLFOUNDATOH PROPERTY UNE <br /> I HEREBY CERTIFY THAT 1 HAVE PRIFPAi¢D THIS APPLICATION AND 7HATTHE WORK WILL BE OOEIE IN ACCORDANCE WITH AAN JOAOUR COUNTY"F"NANCEB ANO$TATE LAWS,AND RULES <br /> AND REGVLATONS OFTHE SAN JOAOUR CDUNIV.HOME OWNER OR LICENSED AOENT'2 SIGNATURE CFJrrIFIE$THEFOLLOWWO:'I CERrWY IMAT INTRE TEREOMANCE OF THE WORE FOR WHICH <br /> THIS PERMIT <br /> IS ISSUED,1 SHALL HOT EMPLOY ANY FERM14 R SUCH A MANNER AS TO BECOME SUBJECT TO WOEKMAN'S COMPENSATION LAWS OF CAUFDRMA.- CONTRACTOR'S INGIMI <br /> MIR <br /> r VMMMAAN'SUI&ICONTBCCOMPENSATION LAWS OF CAIIFORMA-WTHE A"UC T MUST CALL 24�UR <br /> THAT IN THEHOURSINADVANCE FOR ALL REOURm NSPECTIONS,ISSUED, <br /> DRAWING O"BONe SUBJECT 7O <br /> F^Ilium x TITLE: <br /> PLOT PLAN tPRAW TO SCALF)SCALE, •RO <br /> T.NAME: V1.= <br /> AREST TO OR SOUNONIG THE PROPERTY. 4.LOCATION OF HDUBE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> EXPANSION OF SEWAGE DISPOSAL SYSTEM$. <br /> 2. NE ODIMENSIONS AND NORTH DIRECTION. 6.LOCATION OF WELLS WITFOH RADIUS OF ONE HUNDRFD FIFTY FT.ON <br /> 3.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, THE PROPERTY DR ADJORIMG PROPERTY' <br /> iNCAIOMO COVERED MEA$SUCH AS PATIOS.dgVEWAYS ANO WA"S. - . <br /> I <br /> .-- <br /> 4 ... .. <br /> - - - <br /> , <br /> . : <br /> ........ ..... ..... --...t.. /1 V <br /> 5 <br /> .. / <br /> t r <br /> Al <br /> C <br /> .. ROMVE� <br /> Q� <br /> WJ <br /> ... r <br /> I ru; V <br /> W <br /> _ ......ciJlRsiC7N ETT <br /> I sEfiiry <br /> _ E4rTH SEpyiCEs <br /> AL NE7i1'17-{piVISIDf�.... <br /> �. F ARTMEN <br /> T USE ONLY <br /> t DATE: �+ ` AREA- � <br /> APPLICATION ACCMEV BY <br /> F'. <br /> 7AI#L,PIT OR SUMP INSPECTION BY- ( <br /> DATE ! I FINAL INSPECTION BY AT ! <br /> AODITIO NAL/OM rmsS 1 <br /> a P LI � <br /> + f ACCOUN71Na ONLY: Am# FAC# <br /> ` BR I PERMIT NUMBER INVOICE t. <br /> 'L, PE CODE FEE INFO AMOUNT NFMIITED ITEC ASH RECEIVFP BY DATE <br /> ko lt— �• - <br /> 11 0Al <br /> �, Pub.HeaNh'Serv.-Erniro.174(3196) <br />