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APPLICATION FOR UOUIO WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIgAW,,ALTH SERVICES <br /> w ENVIRONMENTAL HEAL XVISION <br /> 304 EAST WEBER AVENUE,ST6;. ON,CA 95202 <br /> 204 4683420 <br /> NOR-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ICBmpbts ID TETplicil*1 <br /> APPLICATION 10 HEREBY MADE TO THE SIV!JOADUIN COUNTY FOR A PERMIT TO CONSTfiiCT AND/OR INSTALL THE WMFK DESCRIBED.TWO APPLICATION 16 MADE IN COMPLIANCE WITH BAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLL CHAPTER 9.111J9p 31 AMP T�E OT!�ARDS OF SAN A COUNTY PUBLIC HEALTH SERR//V_ICE&�EN�VIRON}�MEENTJLL HEALTH OMMON, <br /> JOB ADDREBBIORAAppNN!!fy`✓ C-- /� �,/ CITY f r�Cy G�y^'q/�/i _LOT SIZE <br /> .. n 89 TeJ"'' Z L�C•�/ PIIDNE ~� f-' <br /> A10201 C1 N/` N -- ^� <br /> OWNER'S NAME AODRE .7 <br /> �.,. may/ <br /> COPRRACTOR ADOREBWzy'r L�/tC1CL+.�I 7T'•SAL- �ZO L1Cs s ur PHOHE <br /> .. - BUB CONTRACTOR ADORPBB LION PWNE <br /> TYPE OF SEPTIC WORK: MEW INSTALLATION REPWUADDITION 0 DESTRUCTION C] <br /> DEFT.SYSTEM PERMITTED IF PUBLIC SEYFER 1E AV VAMIN SDD FEET OF OUILDINO.1 PERC TFATI-I I I NOW MANY <br /> INSTALLATION Will SERVE: RESIOENCE I COMMERCWL 13 OTHER 13 <br /> NUMBER OF LINO UMTS. MWIB9t REDROOBES: �$Tot�jA;� <br /> 1 OF tlYIFLOYFp: F <br /> kll OF SOIL TO A OEPTN of 7 !B - �WATMTA�ZDEFTH L%40T1C iJdVKMIREIKE TNAP TYPEIMFO CAPACITY C:7 .COMPM[TMENTB Ot <br /> _ IPKG TREATMENT PLANT❑ dSTANCL To NEARFAT: wELL 6nO 2' FOUNDATIONS PHDPERTY DNE tD � <br /> _ IIF`STATION❑ wF TYPE OF PUMP,,. SAND 61L SEPARATOR IENCLOSED BYSTEMI J I <br /> f LEACRNO LINE NO.S LENIN OF LME. —Y D'�^— INSTANCE TO NLN*@T: d� FOUNDATION lt7 , PROPERTY LINE 7d r <br /> 1 FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY❑ LSNF <br /> q <br /> MOUNDED WIDEN LENGTH DEPTH DISTANCE TO NEARESR <br /> F r I �P � WELLFOUNDATION <br /> PROPERTY LINE <br /> BEPAOEMRS NUMBER� d -TO NEAREST:WEU <br /> POUNOATION',y4 ' -PROERY IWE� ^ <br /> I BUMPS O WIDTH LENOTH OEPT7N DISTANCE TO NEAREST:WCLL FOUNDATION PROPERTY LONE <br /> y DISPOSAL PONDS 0 YawnLENGTH DEPTH dBTANCE TO NEAREST:WELL FOUNDATION PROPERTY PONE <br /> I HERESY CERTIFYTHAT I HAVE PREPARED THIS APPLIOATION D THAT THE VWRK WILL t1E OOHS W ACCORDANCE WITH BAN JOAo1GN COUNTY ORDBNAMCEB AND STATE LAWS,AND RULER <br /> AND REO NS OFTHE SAN JOAQUIN COUNTY.HOME ERORLICENBEDAOENT'SSITFNATURECERTWMMTMFDILOWINO:'ICUMFYTHAT IHTHEPETFOIMLANCEOF THE WORK►ORWNICH I <br /> T1RI6 IB EMPLOY ANY PfNB6 SUCH A MANNER AB TO BECOME OUBJECT TO WORKMAN`*COMPENSATION 1JLWS OF CAUFORNLA.' CONTRACTOR'S HIRNO tlR - <br /> BUB-CO a URE E FIES THE FOLLOWS CERTIFY THAT IN THE PEFSORMANCE OF THE WORK FOR WHICH TWO PERAfT M RBBULD.1 MALL EMPLOY PERSONS SUBJECT TO <br /> WORK AN'.CO BA WB CALL i4 HOUIa IN ADVANCE FON AA/LLALL••REGSRED INSPECTIONS. COMPLETE DRAWING BELOW. <br /> SIG x ,TELE- - DATE: <br /> - PLOT PLAN IDRAW TO OCALIR sCA�c •m - i <br /> ` Y.NAMES OF STEEPER OR ROADS NEAREST TO OR LIDVNpNO THE PROPERTY. - 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PRDPORED , <br /> S.ODTUNE OF THE PROPERTY,VAT"DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL BYSTEYR. I <br /> O,OUAENBIONED OUTLINES AND LOCATION OF ALL EAIOTOq AND PRDPOSED STRUCTURES. B.LOCATION OF v.Uks WITHGN RADIUS OF ONE HUNDRED FIFTY PT.ON <br /> - INCLUDING COVERED AREA SUCH AB PATIO&DRNEWAYB.AND WALAe. THE PROPERTY OR ADJODSND PROPERTY- <br /> ... <br /> ..... <br /> ......, ' <br /> „-. <br /> - <br /> I <br /> ...... <br /> .... .,...... <br /> ........... ............ <br /> Ae <br /> ............... <br /> .......... ... ........ <br /> .. .......... <br /> r , <br /> .... ......... <br /> ................... <br /> .. ........... <br /> .......... <br /> ... <br /> t <br /> t � <br /> ' ..... <br /> p�;f 11998 <br /> L.. <br /> :. . ....,.,........... <br /> ...'>r.� .......... <br /> -: .... r,... ........ <br /> �r1�f14�a SERV G�. .- <br /> .. ........ ... . . ..... <br /> p1rR <br /> .............. <br /> ............ ....... <br /> . .. ..... <br /> .......... <br /> .. ........... <br /> .... .. .... <br /> ........ .... <br /> ......... ...... <br /> rn. <br /> on <br /> FOR MTMSNT USE ONLY // <br /> AFION ACCEPTED BY <br /> DATE.: <br /> { / � iNAL INSPECTION BY GATE 1 I <br /> OR SUMP RNBPECTION BY DATE <br /> V <br /> ! t ADDITIONAL COMMENTS: <br /> I <br /> ACCOUN11N0 ONLY: AIRF FACT ' <br /> F` <br /> ` 4E COeF FEE It" AMODNT RBA RTED CI1EC ASN RECEVED OT DATE M IPum.RMABHK 1NVdCE I <br /> - - PUC.Fiealih$BEv.-E:mrlra.174(3196} ] (/1 nJ2 f <br /> 2O� <br />