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APPLICATION FOR LIQUID WASTE PERMIT <br /> .SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> NOR-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICw*Istw In TrOlimte} <br /> APPLICATION 18 HEREBY MADE TO THE DAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANotoR INSTALL THE WORK bEBCItlBED. TIME APPLICATION to MADE IN COMPLIANCE WITH BAN <br /> JOAOUM COUNTY DEVELOPMENT TITLE.CH pm 9-1110.3 AND THE BTAM[�A M OF SAN JOADUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDREOSIOR APNI Vp 7 ��`/L-I,- ��// /C f CITY A/ p LOT OOZ�Ee, <br /> OWNER'S NAME "/A 4 - ADORESS 7 ;5"]� c4r �G�LC.�/�L�7'.L!s /�-D _ P"ONEr� «s k 6�c <br /> CONTRACTOR //ih /_�G'l��`�2_ AbOf1E66 �U L7C# PHONE <br /> SUB CONTRACTOR AgpItE88 VCS PHONE <br /> TYPE OF SCPTM WORK: NEW INSTALLATION REPAIWAOgTION 13 DEBTMM"ON ❑ <br /> IND SEPTIC SYSTEM PEF"I TTED IF PUBLIC SEWER 18 AVAILABLE WITHIN ZOO FEET OF SURVING-1 PEM TESTM 1 I HOW MANY <br /> AOPSOoSol <br /> 1149TALLATION WILL SERVE: RESIOENCE❑ COMMERCIAL yap OTHER❑ <br /> NUMBER OF LIVING UNITS: J JflifiF4i0F 14i—Ml- MUMBBIS OF IMPLOYM: <br /> CHARACTER OF SOIL TO A DEPTH OF 8 FEET: R4:ff <br /> h P111 UMP SOIL CHARACTER: WATER TABLE DEPT Fl <br /> SEMC TANKIOREAM TRAP ❑TYPEJMm 1"` �L CAPACITY .�X.O>•iCl G�4�--- -NO.COMPARTMENTS , <br /> pKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL r'�r FOUNDATION f} r� PROPERTY LINE <br /> �— <br /> LIFT PUMP <br /> LEACHING LINE ❑P1 NO.&LENGTH OF LINES_TYPE F(p ` lis SMIb OIL SEPARATOR <br /> NCE O NEARES SYSTEM _O L <br /> DISTANCE TO NEAREST:WELL ~�FOVNOATION � PROPERT1f LINE ��- <br /> FILTER SED 13 VMTH LENGTH OEM" DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED D VVIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LME <br /> SEEPAGE PITO ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:VVELLFOUNDATION PROPERTY LINE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST-WELL FOUMDATKIN PROPERTY LTTE <br /> DISPOSAL PONDS ❑MIDT1t LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LME- <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK VAL BE DONE M ACCORDANCE WITH SAN JOAGRIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> AND REGULATIONS OFTHE BAN JOAOUINCOUNTY.HOME OWNERORLICENSEDAGEM'S BMNATURE CERTIFIES THEfOLLAWRIO:'ICERIIFV THAT I MITI E PERFORMANCE OFTHEWORKFORWHICH <br /> THIS PERMIT 10 ISSUED.4 SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' COMRACTOR'S H"wa OR <br /> VUS�CONTRACTINO SIGNATURE CERTIFIES THE FOLLOWINO:I CERTIFY THAT IN THE PERFORMANCE OF THE VVOW FOR WHICH TMS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WOMMAIVO COMPENSATION <br /> LLAA/WW&&OF CALN'ORN1A.' THE APPLICANT MUST CALL 24 HOURS W ADVANCE FOR ALL REQUIRED INSPECTIONS, COMPLETE DRAWM BELOW. <br /> I� StGNEO X � TTTIf: DATE:_ <br />' PLOT PLAN MAW TO SCALL?SCALE—'tO <br /> F <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOVNOWO THE PROPERTY. 4. LOCATION OF HOUSE SEWAOE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION Of SEWAGE DISPOSAL SYSTEMS. <br /> 9. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING ANO PROPOSED STRUCTURES. S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON Q <br /> INCLUOM COVERED MEAS SUCH AS PATIOS,DMVEWAYS,AND WALKS. THE PROPERTY OR ADJOINM PROPERTY. <br /> -..,,...-,., ..... .... .............. .......... .......:........... ........ . . ........ . .. .. - .. .., <br /> ..... ....., .. <br /> ... .... ....... . .. .. . <br /> ......:. <br /> .. <br /> . . <br /> . ...:...... .................................... <br /> ��.: <br /> ... <br /> ...... <br /> T <br /> ak <br /> :... _ <br /> .... <br /> ti <br /> r <br /> ... .... PAYMENT <br /> �iE�V�.. <br /> ..... <br /> fY <br /> .. . SSP 1 j99$ <br /> .. .. .... ... .. ...... ....... <br /> ....:......[SAtv -V .-.... <br />