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I <br /> APPLICATION FOR LIQUI .TE PERMI 59 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERI ICA)) <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388, 445 N.SAN JOAQUIN ST,STOCKTON,4 A�At 88 <br /> (2091468-3420 <br /> 1, <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DAT ISSUE # O l S <br /> (Complete is Trlplicatel <br /> I Application Is hereby made to the San Joaquin County for a permit to construct end/or install the work described. This applicatioi <br /> is made in compliance with San Joaquin County Development Title, Chapter 9-1110.3 and the Standards of San Joaquin County Public Healtl <br /> Services, Envirorvnentat Health Division. <br /> JabAddress/ar MPH# - r y 3o o C e City�c1 Lot Size lC7(} r4�/. <br /> {�a Owner's Name / N Address i►^� Phone <br /> #� contractor <br /> "Contractor Address Lic# Phone <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPAINADDITION I I DESTRUCTION I I PERC TEST(el[I How many---- <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) <br /> Land Use Appfiestioa A <br /> 3 Installation will serve: esfdence�� CosmerciaE_ Other_ <br /> Number of k(u)ng unftsiNumbs of be ra : Number of amployau: <br /> Character of solL to a depth of 3 Leet: 79 P1t/Sump Soil Character: Water Table Depth <br /> PEPTIC TANNiGREABE TRAP HType/Mfg Cepnelty �6G V No. Compartmental_ <br /> i <br /> KD TREATMENT PLANT I 1 Distance to nearest: Weil Foundation Property line i <br /> 4 <br /> LIFT STATION[] Size Type of'Pulp Sand Oil Separator (enclosed system) <br /> LEACHING LINE No. & Length of lines Distance to Nearest: Well ��C} Faundation,�Property Line�� <br /> = FILTER BED 1:1 Width Length Depth ° u WeLL Foundation Property Line <br /> MOUNDED I1 Width length Depth Well Foundation Property Line <br /> I SEEPAGE PITS �Oepth2 Size_Number —1 r� �� Well I� FourdatIon� Property Line car <br /> SUMPS ❑ Width Length Depth a �mWell Foundation Property Line <br /> DISPOSAL PONDS I1 Width Length Depth Well Foundation Property Line <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county Ordinances <br /> and State Laws, and Rules and Regulations of the Sen Joaquin County. Home owner or licensed agent's signature certifies the fol Lowing <br /> 1 • aI certify that in the performance of the work for which this permit is issued, I shall not employ any person in such a manner as ' <br /> r, to became subject to workman's compensation Laws of California." Contractor's hiring or sub-contracting signature certifies the <br /> following: "1 certify that in the performance of the work for which this permit is issued, [ shalt employ persons subject to workman's <br /> compensation laws of California." <br /> 1 The eppikant must rurs In advance for all required Inspections. Complete drawing below. <br /> Signed X Title: Date: — N-99 <br /> s <br /> PLOT PLAN (Draw to Scale) Scale m to <br /> [^, 1. Names of streets or roads nearest to or bounding the property. 4. Location of house sewage dispose[ system or <br /> M` 1 2. Outline ofthe property, with dimensions and North direction. proposed eKpansiiP&fyM osal systems. <br /> 3. Dimensioned outlines and location of all, existingand proposed 5. Location of well i s of 150 ft. on <br /> k structures, includingcovered areas such as <br /> patios, driveways, the property or "EcElp y. <br /> and walks. <br /> OA U IN CO .N' <br /> UB C H I IflN <br /> FitG� <br /> L <br /> r - � <br /> Aw <br /> ri o <br /> FOR DEPARTMENT USE ONLY y <br /> Application Accepted by Date: Are : C� �T <br /> �i Tan Pit or Supp Inspection Date ///1�GFinal inspection by Date <br /> L_f <br /> Additional comments: <br /> ACCOUNTING ONLY: ALAN FAC# <br /> 61' <br /> PE CODE FEE INFO AMOUNT REMITTED ECK CASH RECEIVED BY DATE- SR i PEAMIT NUMBER INVOICE I <br /> a-1 - <br /> Fi <br />