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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOADE#' T.OUNTY PUBLIC HEALTH SERVICES <br /> ENV.. __NMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> {� (209)468.3420 <br /> NONREFUNDABLE PERMIT EXPIRES I YEAR FROM BATE ISSUED <br /> ECompMb In TTIpikatal <br /> +APPLICATION 18 HEREBY MADE TO THE BAN JOAQUrH COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOR(DESCRIBED.THIS APPLICATION 18 MADE PLN COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE CHAPTER 9-111 O.3 AND <br /> THE STANDARDS OF SAM JOAOUrN COUNTY PUBLIC HEALTH BERVICts..ENVIRONMENTAL HEALTH WVIBtom <br /> JOB AODRISSIOR APNJ �?Y'/ D 7 f�l/C D _ _CITY V c LOT 612E 1 <br /> OW NEA'S NAME - ADORE88 r T t PHONE <br /> " CONTRAC70R !�, t-r�L L c- <br /> ADDRESS f ! LPC/ PHONE�,7.✓J I S!..�.5/ <br /> BUS CONTRACTOR ADDRESS LICI PHONE <br /> TYPE OF SEPTIC WORK! NEW INSTALLATION REPAUVADDITIOM❑ DEsvAucTTOM❑ <br /> �INO SEPTIC SYSTELI Psmmt4 IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDIN0.1 POO TESTI.]D I HOW MANY <br /> i APPBoeSeS <br /> 1 tNSTAuA nom WNLaTRVE: REBIPENCE I3 COMMERCIAL❑ OTHER❑ <br /> NIAMBER of IMNO wSta:�NUMBL9l OF BFDROOMI:�a NUMBER OF EMPLOYEES: <br /> CHARACTER OF SGIL TO A DEPTH OFP�3-I FEET: PNISUMP sol CHARACTEN..WATER TABLE DEPTH <br /> F'""-aW"C 7ANKFOREASE TRAP T Ll TYPFIMFOCAPACfTY���L/U ND.COMPARTMENT6 <br /> PKG TREATMENT PLANT 1--I L118TANCE TO IEFJ icm WELL, FOUNDATION c'J �T PROPFA7Y LINE�]�,� <br /> O ❑ 612E TYPE OF PI�M/P SAND OIL SEPARATOR tENCLOSED SYSTEM `J r! <br /> 1 1 LEI ❑ NO.A LENbiH OF LIES Oa DIET PNCE TO NE/VtEBT:YVE11 ' PROPERrY LINE rD�! <br /> -12i FOUNDATION- <br /> LFRTER Bm ❑YMOTH LENGTH DEPTH DIOTANCE TO NEIWEST:WELL FOUNDATION PROPERTY UNE <br /> t MOUNDED I❑Iy--t WIDTH LENGTH DEPTH DISTANCE TO tfEAAEST:WELL FOUNDATION PROPERTY LINE <br /> 11EXPAGE P13 TB FDEPTH sue NUMBER DISTANCE 70 NEAREST:WELL FOUNDATION PROPERTY LINE <br /> StAMPa Q RMO11fL LEN;;t DEPTH O18TANCE TO NPJ1fiEBT:WELL T�-0UNDAiIOH �PROPERTY LINE '+ <br /> OIaPOBAL PONOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST!WELL FOUNDATION PROPERTY LONE <br />! M.I HEREBY CERTIFY THAT I HAYS PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAM JOAGIJW COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE BAN JOAQUDN COUNTY.HOME OWNER ORUCENarD ADENT'B SIGNATURE cERTIRES THE FOLLOWING!*1 CERTIFY7HAT INTHE PERFORMANCE OF THE WOFK FOR WHPCH <br /> 8 PERMIT IB ISBUEO,1 SHRILL NOT EMPLOY ANY PERSON M SUCH A MANLIER AS TO BECOME KMMCT TO VOOFKMAH'S COMPENSATION LAWS OF CALIFORNI&-CONTRACTOR'S WFUNO OR <br /> RUB•CONTRACTIN6 SIONAtURE CERTiF1ES THE FOLLOWING:7 CERTIFY THAT M SHE PERFORMANCE OF SHE WOPK FO11 WHICH TMS PE-Ot IS I-l".1 BHALL EMPLOY PERSONS SUBJECT TO <br /> VOWMAH's COMPENSATION LAWS OF CALIFORNIA.' THE APMCANT MUST CALL 24 MOMS IN ADVANCE FOR ALL REOtBRFD MSPVCTIONB, COMPETE GMWINO BELOW. <br /> Tt <br /> BIONm GI'.'� .l .v TITLE: <br /> x <br /> E <br />� PLOT PLAN(DRAW 70 SCALER SCALE 'to �y <br /> I F..NAMES OF STREEES OR ROADS NEAREST TO ON BOUMOINa THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED L / <br /> OUTLINE OF THE PROPERTY,MNN DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. J <br /> �.3.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, a.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WARS. THE PROPERTY OR ADJOINMB PROPERTY. <br /> ......,. n..-.. 03, <br /> :,...,. .. ...> ..... --. e. <br /> lll��1 .. .. .. .. <br /> ... .... y..... ... <br /> ro <br /> . ! - <br /> 1 <br /> ..o. ......;. ., � ... '^ <br /> o, <br /> ..... <br /> :.. .... <br /> F..es. <br /> a. . ..... .. ...................... <br /> R <br /> . ............. ... ... <br /> .................... .......... .... ............. <br /> ..... .... <br /> .......... <br /> ...... . ............ ....................... <br /> . <br /> tI <br /> I ............... j­... ....... <br /> ............ <br /> iPAYY���p7 .: .. ........ <br /> ¢.... . <br /> JUL <br /> . ..... � 9$4. . . .:.. <br /> >+vvmo <br /> :.. <br /> 'CWF J iG� <br /> FOR DEPARTMENT USE ONLY <br /> -.•.'TVCATON ACCEPTED SY �� DATE: AREA: 2/G <br /> TANK,PIT OR SUMP INSPECTION BY ASE__ 7 22, <br /> FINAL INSPECTION DATEfj <br /> f <br /> KN710NAL COMMFMB: <br /> F <br /> ACCOUNTING ONLY: ADI FACS <br /> CODE�T � INFOAMOVNT`DyILJn E4l�ASH RECL4VE0 BY 7 ar y�L SR 7 PERMIT NIENB@L IMVOLCE I <br /> Pub.HeBWT SBIY.-Enviro.174(3195) <br />