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APPLICATIONUQWQ WASTE PERMIT t SAN JOAQfJ"'�*COU NTY PUBLIC HEALTH SERVICES tJ ENL_ .,NMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468.3420 F OK-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Camplab In TH POCIltal APPLICATION IS HEREBY MADE 10 THE SAN JOAQUIN COUNTY FOR A PERMT TO CONSTRUCT ANDIOR INSTALL THE WOR(DESCRIBED.THIS APPLICATION 18 MADE IN COMPLIANCE WITH am JOAOCOUNTY DEVELOPMENT TITLE UIN ,CHAPTER 9.1110.3 ANA BTANOAROE OF RAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES.ENvawNMENrAL HEALTH DMINON. / JOB ADORESRMR APNF L�"� !_J� CIPY t LOT SITE I`7-A LLONREER'B NAME LD ADO M -- 4J l YCX PHONE 'F CONTRACTOR 4v'v CS�d_Sb LMS ADDRESS_-.-�{,{lnC� a tA,i SV L>t � ' /dl] 7 _ PHONE RUB CONTRACT011 ADTRIEso UCS PHONE FTYPE OF SEPTIC WORK: NEW INSTALLATION 13REPMII/ADDTRON DESTRUCTION❑ IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 10 AVASABI(WITHIN ZOO FEET OF BUILDIND,1 FERC TESTW 1 1 HOW MANY ' APPSwSon f INSTALLATION WILL SERVE; RESIDENCE& COMMERCIAL❑ OTHER❑ fMENSeI GP-12 IIHITtf�NIIRR.OF SEDROOMa: �TASK .of RIPLOY ; i F DFSOILTOADtMOF7FTET: PrrMUMPSORCHARACTER: WATFRTASLEDMH�SEPTIC TANKIvIEASE TRA► ❑TYPEWF0 CAPACITY NO.COMPARTMENTS PCD TREATMENT PLANT❑ dBtAMC!to NEAREST. WELL FOUNDATION PROPERTY LINE LIFT STATION❑�.SfIZE TYPE OF PUMP SAND OB.SEPARATOR IENCLOS[D eYaTEMI _ ;I LFACHINO LINE 114•NO.•LENGTH OF LINES f� („IND DISTANCE TO NEAREST:wELL L TOUNDATIOH 6S FRDPEPTY LINE_ �f0 FILTER Rm 13 WIDTH LENGTH DEPTH INSTANCE TO NEAREST:WELLFOUNDATION P1OPE11TY LINE ..MOUNDED ❑wOTH LENGTH DEFM DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE PITS O DWTt BITE MMBER DIRTANCE TD HEAPEST;WELL FOUNDATION PHoRERTY LINE 'SISRPS 13mDTH LENGTH DEPTH DISTANCE TO NEAREST:WELT FOUNDATION PROPERTY LINE pSPOSAI FONDS 0 WIDtIK LENGTH OEPrH INSTANCE TO NEAREST:VYELL FOUNDATION PROPERTY IEEE 1 HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE NSrH RAH JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULER MID REGULATIONS OF THE 9AJI JOAQUIN COUNTY,HOME OWNER ORLICENSEO AGENT'S WONATINIE CERTIFESTHE F OLLONTMO;'I CERTIFY THAT INTHE PEISOIMANCE OFTNE WORK FORM hl” PHIS PERMIT IS HI81IED,1 SHALL NOT EMPLOY ANY PERSON IN BUCN A MANNER AS To BECOME ffUEJECTTO WOWMAWS COMPENSATION LAWS OF CALTORMA.• CONTRACTOR'S WRNS OR UB-CONTRACTOM F E CERTIFIES THE FOLLOWOM:•I CERTIFY THAT IN THE PERFPRMANCE OF THE WOFK FOR WHICH THIS PERMIT 19 ISSUED,I SHALL EMPLOY PERDONR SUBJECT TOORKMAN'S COM N LAWS OF CALrFORQr • THS APP ICANT MUST CALL b HOURS IN ADVAIICE FOR ALLLLMISOWRED 111011LTIONS. COMPLETE ORAwING 91LOW,BbTlED>< -• --:.._ TILE, r 6/1 z L r PLOT PLAN roMW tO SCALE!SCALE •[e - i R.NAMEa of STILETS OR IIOADIS NEAREST TO OR MOUNDING THE PROPERTY, P-AQ jf 'F4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM on PROPOSED ' „Z. OUTLINE OF THE PROPERTY,WITH DIMMOM0 AND NORTH DIRECTION. th /Y 1" r' EXPANSION OF SEWAGE DISPOSAL nWEUe. 3.dMFNeloNEO OUTLIER AND LOCATION OF Alt EAIBTINS AND PROPOSED STRUCTURES, FF��e-3-,+�jI ,i.LOCATION of WELLS OF Ol7E HIINDIIED FTIF7Y F7.ON INCLUDING COVERED B SUCH AS PATIOS,DRIVEWAYS,AND WALRB, THEI7IDPERFY OR AD" ' 3AAr�pa .;. .... .-..<.. .. P BIfG HF7 . �� X999 c�tv�Ror�MEI Es /O�. � nrral_.yFA�r�rnvl5r �N ¢... rr �IL7H ... t . .... . / - a. ....ELLE :.. I �K .-._. - I ....., ... -__ ..,_.... .. .. : ........ ........ .................................... .......... ....... ....... ............. .......... ........ :.. . .:;.�� ;.. . ....... ........ ...... .... _ .......... `� i . ...<. ...:.... it .......... .................. DEPAR USE ONLY �I ---APPLICATION ACCEPTED SY C GATE: L rrTANK,PIT OR BUMP INSPECTION BY DATE___L I FINAL INSPECTION BY DATE 11bd1 bNAL COMMENTS: I AccDImTNKG oxLr: Mw FAcf +� -I rikcol5f� In INRI AMOUNT1 RFAN H REc BY OAT SR IFERNST H OLA INVOICE f I'/3 II i F t Pub.Health Sere.-Erlviro,174(M) + i