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APPLIVINFOR LIQUID WASTE PERMIT <br /> I. SAN JOAOUI'6-OUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> j � (209)456-3420 <br /> I I Rpll•REFUIIUAELE ERMI EXPIRES TEAR FROM DATE ISSUED <br /> (Cimpblf In T1IpFNalel <br />{ APPLICATION m HEREBY MADE TO THE SAH--IN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOW DESCRIBED.THIS APPLICATION IB MME IN COMPLIANCE WITH BAN <br /> i J 11.11 COUNTY DEvLwPMENT TITLE.CHAPTER 81110.3 ANO T STANDARDf OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. .(�y <br /> F. L LO7 SIZE 4T1f1 rL <br /> s JOB ADORESSIOR APNIF �7 {� <br /> A..,IS ,/4 ! e ,CQ C' PHONE_ '7 <br /> -�OYyNTn'e NAME Ctirv�CS�,d--S b �..�AOORESS si UO0 I�L a W`L Son <br /> w 0.�yCF ��OJ PHONE Y -�(�0 1 <br /> CONTRACTOR J <br /> TT���^^' AOlBIE88 UCP 17fDHE <br /> 1 -B1I6 CONTMCTOR <br /> Te NEW INSTALLATION❑ xFFAOUAOD1T10M DFATRUCTIOM <br /> 4 r TYPE OF SEPTIC wORK: FERC TESTIA 1 1 HOW MANY <br /> RIO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING-1 APO-0—• <br /> HISTALLATION WILL SEWE: RESIDENCE COMMERCIAL D OTHER <br /> NUMRDL OF WINO IIOfT.:�,^NUMBER OF SEOIIOOMi- NUMBER OF FMPLOYEFS; <br /> CHARACTER con.60TO A DEPTH OF 9 FEET: <br /> pITISUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> CAPACITY ND.COMPARFMEHTS <br /> fEPRC tANIIIOREASE TRAP ❑TYPEMHTO PROPERTY UNE_ <br /> I PRO MEATMFMT RANT❑ DISTANCE TO NEAREST: WELL FOUNDATION <br /> LFT STATION❑ SITE TYPE OF PUMP BAND OIL SEPARATOR REHCLDSED SYBTEMI I <br /> -� E MUIDATMN�T 'Y MEAL--�- <br /> 'I <br /> LEACHING LINE )(NO.•LF}IOTH OF LINES ��� DISTANCE TO NEAREST:WELL <br /> FILTERBED E3 VWDTH LEWOTH <br /> DEPTH p9TANCE 70 NEAREST•VIELL FOUNDATION PROPERTY UNE <br /> [3 WIDTH LENGTX DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED PROPERTY LINE <br /> 8T2E NUMBER DISTANCE TO NI:MEST:YYELLFOUNDATION <br /> SETPAOS HTi [I WDFH FOUNOATION PROPERTY UNE <br /> 61SAM �YNDTH LLNOTH DEPTH DISTANCE TO NEAREST:1VELL <br /> pirofAL romps I]vVIDTH LFNOTH <br /> OEPTH DISIANCE TO NEAREST:WELL FOUMAMN PROPERTY UNE <br /> _ 1 HERESY CERTffYTHAT 1 HAVE PREP THIS APPLICATION A770 THAT THE WDPK WILL BE OO NE IN ACCORDANCE WITH SAN JO IN COUNTY ORDINANCES ANO STATE LAWS.ANO RULES <br /> AND pE0UlA71DNs OF THE SAN JOAOUINCOUNTY.HOME OWNER ORLICENSW AGENT'8 W0HATWIE CERTIFIES THE FOLLDNfIN6:'ICENIFYTHA7LATHE PERFORMANCE OF7HEWORK HRINICH <br /> TLIe1vIMR If IBSLID.1 SHALL NOT EMRoY ANY PERSON M SUCH A MANNER AS TO BECOME WUSAECTTO WORKTAAN'S COMI4NSATION lA1IIs OF C11E1F01w1A MMrtACTOR'S HIRING DR <br /> I BUBLONTRACTIN6 00 HOURS RE CERTIFIES THE FoLLOWINO:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOW <br /> FOR WHICH THIS PERMIT 1f ISSUED,I SHALL EMPLOY PElIOONs eUeJECT TO <br /> WORKMAN'S COMPEryIF^tl N LAWS OF CALIFORM 'THE APPLICANT MUST CALL M XOURf IN 7rrLE'.­LEL--.Al' <br /> NCE FOR ALL REQUIRED IxiPECTTONs.COMPLETE DRAWING BELOW. <br /> / <br /> SgNID X <br /> +(4 "� 1 <br /> PLOT PLAN Ipwlw TO SCALER SCALE 'IP <br /> `f-4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> I 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE I7ROPEIRW: .1 4 r E.LOCATION OF YYEu.f E Of"SAL SYSTEMB. <br /> 7.01TTIlNE OF THE PRDPERT'f.WITH DIMENSIONS AND NORTH DIRECTION. F� ¢.,;,- r OF ONE HUNDRED FIFTY FT.ON <br /> 3.DIMENSIONED OUEMEt AND LOCATION OF ALL EXISTING AND PROPOSED STHLICTVRES, "�..i�G THE T'IROPERTY OR ADM <br /> IWLUDM COVERED 0 PIEAS SUCH AS PATIOS DMVEWAYS.AND WATKs <br /> o. HEALTpi <br /> .. - .. _ WYIAONMEN7A , <br /> T tiFg7NS'3i <br /> � I;r -11iL <br /> 3 �, cs- b <br /> ..,q k'�" w <br /> u e� <br /> �. �..... <br /> f...a <br /> ,td ..... _ t11 o � <br /> a . n; <br /> + ... � w <br /> F 7 . <br /> I ... " ............ <br /> ............. <br /> .......... <br /> ....... ..... .......... <br /> ............ <br /> ................ <br /> ... ..... ..... <br /> ............. <br /> ........... j <br /> ... ............ <br /> r.............. <br /> ............. <br /> -v <br /> I � ,�, F DEPAP USF ONLY Zt <br /> L DATE: <br /> APPLICATION ACCEPTED BY <br /> + pATf 7 J_FINAL INSPECTION BY DATE f <br /> sF ORSUMP1NSPECTIDH BYF,::,,prt <br /> NAL COMMFNTS: <br /> I ACCOUIIT1xs ONLY: <br /> AIDP FACT <br /> } eY DA PEWIT <br /> I PEWIT NUM69L INVOICE F <br /> PECODE FEEINFO AMOUNT RDNREC <br /> RI ITEC SN <br /> FPub.Heab Sam.-ErMro.174(3196) <br />