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APPLICFOR LIQUID WASTE PERMIT � � <br /> SAH JOAOUI. -OUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 85202 <br /> (209)468-3420 <br /> NON-AFFUNDADIE PERMIT EXPIRES 1 YEAR FROM DATE ISSUfp <br /> APPLICATION 16 HEREBY MADE TO THE SAN JOAOVIN COUNTY FOR A PERMrr TO CO�FIBTB In Trlpr.t.) <br /> JOAOUIN COUNTY DEVLTOPMENr TITLE,CRAFTER 0.1110.3 AND THE BTANDARDB OF BAN JOAOURN COUNry PUBLIC HEAL7:7TH BETMCEB.ENViPOHMEMAt'REALER COMPLIANCE <br /> y CONSTRUCT AND/OR INSTALL THE WORT(DESCRIBED,THIS APPLICATION IB MADE IN COMPLIANCE WITH SAN <br /> ' C <br /> .JOB ADORUSIOR APNT <br /> L <br /> O WHER'B NAME nE, <br /> /I c-— 4' <br /> ADORE SS LOT BIZE 6 ++�t <br /> CONTRACTORll� i C PHONE C LZ' 3 <br /> AbDRESe_ Cji /'t7 f7 UCd'DVB CONTRACTOR FHOHE (�^5 1' <br /> MDIiLB6 <br /> l!<e <br /> 7YPE OF EEPHC WORN; NEW INSTALLATIONPHONE <br /> I� — <br /> IND SEPTIOREPNWAOdTION U DESTRUCT1011❑ <br /> SYSTEM 1'NOIIN-TED IF PUBLIC SEWER e8 AVARABLE WITHIN 20D FEET OF BLIBAINO.1 <br /> I ►9eC TEBTI.i 1 i LIDW MANY` <br /> IN4TALLATION WILL SERVE: RESIDENCE'LR COMMERCIAL E3 OTHER❑ APPBe.tieA• <br /> .NVMBq OF LIVING VMTB: NUMBER OP BEDROOM8: <br /> ,CHARACTER OF STO A�d P,r. — <br /> OIL NUTAM Of EMFLOTE : <br /> BEPRC 7ANxfO1EASE TRAP 1�1 PITISVMP SOIL CHARACTER: WAT[n TABLE bEPIH <br /> IJ TVPEIMFD / CAPACITY "•"`s I <br /> PKO TRGTMEI/T RAM 13 DISTANCE 70 NEAREST: NO.COMPARTMENTS <br /> 1 WELL �� PoUNDATON LS%l" <br /> F '/J� TYPE OF—P �PEPITY <br /> [LlAciiNg URE r/ BAND OIL bTPARATOR'ENCLOSED SYBTEMI 1 <br /> �I NO.B IENGTN OF LINES p4 <br /> FILTER SEO DISTANCE TO NEAREST; / <br /> O WIDTH LEN13TH � PoDNLIATION '�$ PROPERTY UNE :d f-! <br /> CI IMDTH _ CPTH DISTANCE TO NEAREST:WELL FOUNDATION _ ~ <br /> MOUNDED LINE <br /> dEFPApE FIis 0 DEPTH 6'E DEPTH DISTANCE TO NEAREST:WELL rOUNDATION PROPERTY UNEP~ <br /> 611111Pd 1A70TH / NUMBER DISTANCE TO NEAREST:WELL <br /> FOUNDATION <br /> DISPOSAL FONbB Q11AbTH �NbTH.��DEPTH �/7 DISTANCE TO NEAREST;_WELL JK 7FDUNDATibN ����pERyy UNF } <br /> FNM DEPTH-�Cy� �ri�,R,, Y LINE e�4� <br /> DISTANCE To NEAREST:WELL FOIlNDATON <br /> CERTI <br /> TV LINE <br /> NER EG LATION OF T I HAVE PRFPAAEC THIS APPLICATION AND THAT THE WORK W91 BE Da HE IN ACCORDANCE WITH BAN JOAOUIN COUNTY ORDINANCES TE LAWS,AND RVLE9 <br /> AND REGULATIONS S E THESARJNOT EMCOUNTY.HOME OWNER OR UCEN13M AOEHT'a BONATURE CERTIFIER THEFOLLOWBRT:•I CFRrIFY7OUNINTHE <br /> TI68 PERMIT IS ISSUED,I SHALL HOT EMPLOY ANY PERSON M SUCH A MANN"A9 TO SECOME SUBJECTTO WORK UAW M!'I C RrIF"LAWS OF CALIFORNIA.- CONTRACT ' <br /> _9Ug•IMAN'D COM 8N ATI ORE CEATIPIES THE FOLLOWING:7 CERTIFY THAT M THE ALIFO MANCE OF TIRE WORT FORING OR <br /> `BMOMCMAH'B COMPENSATION LAWS OF CALIFORNIA.' THE APPUCANT MUST CALL 24 �NC�AN*CF FOR AAR F WHICH�FERMIT IS�TIONi.ISSUED.I S AU EMytoy <br /> BELOW, o CT TO <br /> COMPL <br /> aNED x !� 1 <br /> 7mE:� DATE: <br /> PLOT P"A"WFMW TO BCALEI BGAJ-E Y <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDINO THE PROPERTY. ~`~ en I <br /> 3- DIMENSIONED OUTLINES AND LOCATION 7.OtTTLBVE OF THE pppp[RTY.WITH DIMENSIONS AND NORTH DIRECTION. 4.LOCATION OF HOUSE SEWAGE DIBPOSAL SYSTEM OR PROPOSED <br /> J <br /> ALL EXISTING AND HIOTOSED STRUCTIAES S. <br /> e, <br /> HUNDRED FIFTY FT.ON <br /> THE PRO <br /> DRIVEWAYS,AND WAUCe LOCATION OF WELLS WITHIN RAORId <br /> MCLVD'RO CO <br /> .. FERrY OR ADJOt"M PROPERTY <br /> COVERED AREAS SUCH AS PATIOS, .... ..:._ _.. <br /> 7. <br /> bF ONE i <br /> 1 <br /> OF <br /> o.. <br /> .. _.. ... <br /> .. ... <br /> i <br /> v <br /> V <br /> l,j0 p Fes. i T— <br /> � 4 <br /> .... ., <br /> .c._-., _ <br /> FdE9� r <br /> J <br /> 2 X 19 $... <br /> ... JOAQ <br /> ... ... ^- <br /> ENVIiiONM�lY���ER�gyp <br /> .. H' fusrcat <br /> ... <br /> ... .. <br /> nA � FOR DEPARTMENT USE ONLY <br />�PF'UCATON ACCEPTED BV �/ <br /> � <br /> / <br /> GATE: <br /> PAREA '214 <br /> ANK H OR St"INSPECTIOII BY '' <br />+ <br /> PATE—L 1 FINAL INSPECTION g 1� 7 g <br /> DgTIONAI COMMENTS: (i G GATE / L8L} <br /> t r j- <br /> ACCOVNNNO ONIY: Aro/ <br /> FACT <br /> I.`' !1r PE�CObEFEE INFO AMOUNTPIMM1TED �ICASH RTCBYTD BY DATE AR IF¢ONIT NIIMBDI <br /> Imo' W ID <br /> S/ /D'` INYPICE. <br /> :/ <br /> 1 Pub.Health Serv.•E,,iro.174(3198) <br />