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f APPLICATION FOR UOUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> f (209)466-3420 <br /> SON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE 199"D <br /> I me-11Iete In Mp1'iphl <br /> i APPLICATION IS HEREBY MAGE TO THE BAN JOAOUIN COUNTY FOR A PERMIT To CONSTgUCi ANDA)q INSTALL THE WORE DESCRIBED. THIS APPLICATION IB MADE IN COMPLIANCE NRIH SAN <br /> 7`•- JOAOUIN COUNTY DEVELOPMENT TITLE.CHAPTER 8-1110,9 AND THE STANDARDS S SAH AND'oN COUNTY PUBLIC HEALTH RIBED.SERVICES.S APPLICATION 0 HEALTH COMPLI <br /> FElil JOB ADDRESSOR APNI 2:2 �' S` <br /> LOT S12Ey//� <br /> OWNER'S NAME <"/ <br /> COMPACTOR PHONE -3 <br /> li ADDRESS P"�'� <br /> PHONE <br /> SUBCONTRACTOR ADI7RE58 <br /> TYPE OF SEFTIC WORK: NEW INBTALIATION❑ REPAIA/AbDRION OFATRUCRON❑ <br /> ONO SEPRC SYSTEM PERMITTED IF PUBLIC SEWER IS AVARABLE WITHIN 200 FEET OF BUILD II <br /> FDIC TFJPTR+1 I I HOW MANY <br /> INCTALLATION WILL EERVE: RESIbb/CF/,(J. APPL'dtlen f <br /> / �,����!!!! COMMERCIAL❑ OTHER Q <br /> -� NUMBER OF LIVING 111;70: / NIAEBER OF EMMOOMS: <br /> ��EPTHO NUMBERCH OFEMRGYEFA: <br /> 11 I <br /> CHARACTER OF 800.11.A DEPTH OF S FEET;(vlwli� liZ/ PR/SUPiIp•SOIL CHARACTER: wATL71 TABLE DEPTH� I <br /> SEPTIC TARRANWASE TRAP ❑TYPEIMFO CAPACRY <br /> NO.COMPAMMENrS <br /> PLq TREATMENT PLAly7❑ DIB7ANCE Tp NEAREST: WELL FOUNDATION PROPERTY NNE <br /> UFT STATION❑ BRE -TYPE OF PUMP BAND On.SEPARATOR M14MOGED SYSIEMI <br /> .I LEERRE NNE NO,i LENGTH OF LINES <br /> FILTERLT@I EFb Q! bUITANCE TO NEAREST:WELL� O /FOUNDAMN PROPERTY NNE_ld-S I <br /> ❑WIDTH LENGTH DEPTH OISTANCE TO NEAREST:WELL MLMOATION <br /> PROPERTY NNE <br /> r�r MOUNDED [3 WIDTH LENGTH IXPrH . DISTANCE To NEAREST: <br /> WELL FOUNDATION PROPERTY LME <br /> SEEPAGE PRE DEPTH SPE_ �/! NUMBER_L DISTANCE TO NEAREST:WELL/SV,FOUNDATION-Zj L1/ PROPERTY NNE/d D <br /> Si1MPS L]WIDTH <br /> DIiPOEM POMbi WIDTH <br /> DEPTH ION DISTANCE TO NEAIIEST:WELL FOUNDATPROPERTY LINE ` <br /> ❑ LFNGT/1 DEPTH DISTANCE TO NEAREST:WELL. FOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTIFYTHAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOR(WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> RR AND REGVUITgNS OF THE SAH JOAQUIN COUNTY.HOME OWNER OR LICENSFO AGEM'e SIGNATURE CERTIFIES THE MU.OYyLNG:ry CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FORWHICH <br /> THIS PERMIT 19 ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS To BECOME SUBJECT TO WOMMAMB COMPENSATION LAWS OF CAJJPORSA,•COPITRACTOFre WINK[OR <br /> SI1B-CONTRACTING SIGN M CERTIFlE671rt FoILRWYIHG:'I CERf1FY THAI IH THE PT76pRN1ANCf OF THE WORK FOR WHICH THIS PEFIMI7 IS IBM,,,I SHALL EMPLOY PERSONS BUBJECT To <br /> + 1A/OISCMAPI'S COMP KIN l.AwB OF CANFpPVAA,• HE APp1JOAHT Mvi7 CALL bl HOURS pF 11pVANCE/ FOR ALL REGURED INSPECTIONS.COMPETE DRAWING BELOW.✓/j (dam <br /> PLOY PLAN 1bRAw TO SCAL[I SCALE -le Q <br /> „ I.NAMES OF STREETS DR gOAOB NEAREST TO OR BOUNDING THE PROPERTY. R <br /> 3.OUTLINE OF THE PIOPERty,WITH DIMENSIONS AND NORTH DIRECTION, 4.LOCATION RF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> Z.DIMENSIONED OUTLINES AND LOCATION OF ALL fX19TWG AND PROPOSED STRUCTURES <br /> EXPANSION OF SEWAGE DERMM Bryurrms. <br /> INCLUDING COVERED AREAS SUCH AS PATIOIL DRVEWAM AND WALLS ONE HUNDRED FIFTY R.ON <br /> 6. <br /> LOCATION OF WELLS LA'rTIRIN RAOn18 OF O <br /> THE FROPERI'1'OR ADJOINING PROPERTY <br /> ...... ...... <br /> ............ <br /> .... .............. <br /> .... . ........ <br /> ................ ......J .... ............ <br /> ............. ....... .... <br /> .......... <br /> ....... <br /> ...:..... .... ..... ...... <br /> ............ <br /> ................. .......... ..... <br /> .. ,.,. <br /> ............ <br /> .... ........... ...... <br /> . ........... <br /> .... ....... .... :.. t .. <br /> ..... <br /> y <br /> .......... <br /> .......... ........... <br /> .. ........ <br /> ........... <br /> I <br /> _... <br /> ... ... ...... <br /> ... ... ... .... <br /> ................ <br /> .............. <br /> ............ <br /> �s ........ ... .. ............. <br /> : a <br /> ... .t _ <br /> v: <br /> u <br /> FOR DFPM7NIETRT USE ONLY I' <br /> APPLICATION CEPTEO BY DATE: ARE <br /> TANK/PYOR BUMP INSPECTION BY tlAT / FINAL nf9PEGTION HY Y / A <br /> i <br /> ADDITIONAL COMMENTS- - �• / ii <br /> ACCOET <br /> NLY: A1DI FACT <br /> i PE COFEE INFO AMOUNT REMITTED 1 KITABH RFCENEb SY DATE SR J P6RRT <br /> �L NKBMBSL INVOICE <br /> 2 J d <br /> Pub.Heeflh Serv.-EnATO.174 18196) <br />