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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 /> NDN•REFUNDABLE PERMIJ EXPIRES 1 YEAR F DM DATE ISSUED <br /> ICemplete IN Tripkati) <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOFK DESCRIBED. THIS APPLICATION le MADE IN COMPLIANCE WITH BAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARD@ OF SAN JOAOUIN COUNTY PUBLIC HEALTH SEES ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADOREeSfOA APNRI CITY <br /> rl LOT SIZE <br /> 1PHONE <br /> OWNER'S NAME ` ADDRESSlgie'."3x <br /> LlCI��PHONE <br /> CONTRACTOR 'fllt,- ___ADDRESSB2h=—C== <br /> uC# PIIONE <br /> SUB CONTRACTOR <br /> ADDRESS <br /> I!` TYPE OF SEM 10 WORK: NEW IN4TALLATT0N RWA@UADOITION ❑ DESTRUCTION❑ <br /> IHO SEPTIC SYSTEM PERMRTEO IP PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING-) FERC TEST{.1 E 1 HOW MANY <br /> AF4eO-MY^/. <br /> INSTALLATION WILL SERVE: RESIDENCE❑ COMMERGIAL)q OTHER 13 <br /> NUMBER OF LMNO UNITS: ftmu R OF aEDROOMi: NUMBER OF BMPLOYI S: <br /> CHARACTER Of SOiL TO A DEPTH OF 3 FEET' PIT/SUMP SOIL CHARACTER. WATER TABLE DEPS <br /> HL <br /> + EUVM TAN E TRAP jo TYPE/MFii 4 CAPACITY NO.COMPARTMENTS <br /> PKA TREATMENT RANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> UFT STATION❑ TIRE TYPE OF RUMP SAND OIL SEPARATOR IENCLOSED SYSTEM! <br /> LEACHIfW uNE NO.S,LENGTH OF LINES Z--1 iJ�'V _DISTANCE TO NEAREST:WELL FOUNDAT10N PROPERTY LINT <br /> — <br /> NO. <br /> RED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> MOUNDED 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST'WELL FOUNDATION PROPERTY LANET,.,,,r <br /> iEgAGE RT4 'm DEPTH a12'E, NUMBER�„�DISTANCE TO NEAREST:WELL,&„FO mums 4 V PROPERTY LINE— Q`J <br /> aDFAPa ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUMAT!O" PROPERTY LIRE <br /> I DISPOSAL PONOS 0 WIDTH LENGTH DEPTH_DISTANCE TO NEAREST.WELL FOUNDATION PROPERTY UNE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION ANO THAT THE WORK WILL BE DONE IN ACCORDANCE YAM SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> AND REGULATIONS OFTHESAHJOAOIIMNCOUNTY.HOW OWNENt*LICENSEDAOENT'SWONATURECERTSTESTMFOLLOWINO:'PCUWWVTHATMITHEPUfOFOAANCEOFTHEWOPKFORNMICH <br /> THIS PERMIT m MOOD.1 SHALL NOT EMPLOY ANY PERSON IN SUCH'A MANNER AS TO SECOME SUBJECT TO WDAKMAI'S COMPENaATOM LAW@ OF CALIFORNIA'. CONTRACTOR'S WRING OR ([� <br /> 8USi:ONTRAGTMO SIGNATLIRE C S THE FOLLOWING:'1 CERTIFY THAT M THE PERF004ANCE OF THE WOM FOR WHICH THIS PUVWT m MSUED.1 SHALL ETMPLOY PERSONS BULNECT TO V <br /> WORKMAI!'S NSATION LAW@ F C RNIA.' THE APMUCANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REOUSRED INSPECTIONS. COMPLETE DRAWING BELOW. <br /> SIGNED <br /> TITLE: _ DATE• <br /> PLOT PLAN CRAW TO BCALEI SCALE 'to '1 <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUBE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. - MANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 2. DIMENWONEO OUTLINES AND LOCATION OF ALT.EMOTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLa WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS, <br /> ........jTHE PROFEMY OR AOJOI}11NG PROPERTY- <br /> .... <br /> /{ <br /> .. - o . . i►> j... ................. , k:� <br /> ... ...- .. .' .F.. ..._....... ...... <br /> I1 *: .. a <br /> .. .�.. .. .. . . <br /> : � <br /> __ _. <br /> .. .. <br /> w. <br /> ..... .........:. .. .. <br /> . . . . . . . . . : <br /> . . <br /> P... <br /> ..... <br /> ...... ...... . : .. ......... K <br /> JOA } ���C S .. .. <br /> Lil?1;fF1. V1St�i.., r-�... .. ....... <br /> �Girtff pLTMfit <br /> � yQC3N� <br /> . <br /> n ...... <br /> :... <br />