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000.�j k <br /> APPLICATIDP`{.OR LIQUID WASTE PERMIT <br /> SAN-JOAQUIN', RATY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 988,304 EAST INE SEER AVENUE,STOCkTON,CA 55201.988 <br /> (2091468-3420 <br /> NON-REFUNDABSE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Moirkplfts In TrolkaTfl <br /> APPLICATION 18 HEREBY MADE TO THE BAN JOAOUSI COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED.THIS APPLICATION IB MADE IN COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.31AND THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HFALTN1 SERVICES.ENVMmmwrAL HEATH DIvimoN. <br /> oz- <br /> 8 ADDREeflOR A",-21�__ f�' /y� r V�i��'e. CITY_L,.'ADA PLOT E�Eaf, <br /> FMEn'$NAME- �.q►F, }yC� 1� 'VP0 'A `ADDRESS 1I'Tres �� PHONE. <br /> CONTRACTOR �/� ADDAEBB LICE PHONE ^� <br /> �!CONTRACTOR Y P N' ADDRESS. t% AD—< [9S 11Crco,-')9SG-�j PHONE -.L-7113 <br /> ..PE OF SEPTIC WORT: NEW HNITALLATIONtal REpA1R1ADDFIIOf1 (3 DESTRUCTION❑ <br /> INO SEPTIC SYSTEM PEIIMITTED IF PUBLIC SEINER 18 AVAILABLE VWMIN 200 FEET OF BUILDING.) PERC TESTIsI f 1 HOW MANY <br /> APPM rdtl <br /> FTA:�Tfll.WILL.TAVE; RESIDENCE COMMERCIAL 0 OTHER 13MBF ENI.I14TS:,--�—NUMBER Of IEDROOM2:--3 NUMBER OF EMPLOYEES: `F <br /> CHARACTER OF SO0.TO A DEPTH OF 3 FEEE: PIT/SUMP SOIL CHARACTER: { WATER TABLE DEPTH G <br /> SEPTIC TANKMAEASE TRAP r'�P'rYPE/ IMFO 8�6 L 075'{1,g"FeCAPACITY l a a� �NO.COMPARrmENTS cam. <br /> 2 TREATMENT PANT❑ pBTAME TO NEAREST: WELL­�1 FOUNDATION I,IL! PROPERTY UNE_aS:!_ <br /> ^Ik' UFT STATION 0I1--ME'� TYPE OF PUMP "NO OR SEPARATOR(ENCLOSED SYBTEMI <br /> LEAAIfNO LINE y^NO.\LENGTH OF LINES 1 ..—DISTANCE TO N"M'FT:VVE7L--L-& FOUNDA,TpN_!&_PROPEMY LME . <br /> FILTER BED ❑WROTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> �UNDm ❑WwH LENGTH------- DEPDISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> ♦PAGE PITS EhVEPTH _BUR <br /> DEPTH,Y NUMSER 3 DISTANCE TO NEAREST:WEu�PoUNDATION G DI PROPERY ERIE �1,-ST <br /> ..,MPS ❑5 WIDTHy--'�LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> I�J . <br /> DISPOSAL PONDS LVMp7H RENOIR DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY i1H1E n <br /> EREBY CEATIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE 1NORL WILLIE DONE IN ACCORDANCE WRHI BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AHO RULES <br /> OREGRMTIONBOFi THE CAN JOAQUIN COUNTY.HOME OWNEROR LICENSED AAENT'e SIGNATURE CERTIFIES THE FOLLOLMNO:•1 CLT "THAT IN THE PERFORMANCE OFTHE WORK PORWI/ICH <br /> IS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBACT TO WORLMAYS COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'/HIRING OR <br /> SV&CONTRACTING StGNATIIRE CERTMES THE FOLLOWINO:'I CERTIFY THAT M THE PERFORMANCE OF THE WOFK FOR WIMCH THUS PERMIT IS ISSUED,I SHALL EMPLOY PERBONB BUSATT TO <br /> WOWMAN'S COMPENSATION LAWS OF CALIFORNIA' THE APPLICANT MUST CALL 24 MOLL S IN ADYANCE FOR ALL PECUW 1D INIPL'CTIOII8. COMPLETE DRAVWHG BELOW. <br /> c <br /> F.X TITLE: _�^A�1�}s C�6 r r9 <br /> PLOT <br /> DATE: <br /> _ft) 16-PLOT�PLAN LDWAW TO SCALE)SCALE •b . <br /> 1,NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PAGI ODED <br /> OUT ELIN <br /> NlT E OF PROPERTY.WLTH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> DIMOUTLINED AND LOCATION Of ALL EXISTING AND PROPOSED STRUCTURES, N.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED MEAS SUCH At PATIOS DRIVEWAYS,AND WALLS. THE PROPERTY OR ADJOINING PROPERTY. <br /> .. ...I� - -....,. ... .... .. - .. <br /> ... '. ..r. ..,. - <br /> :.;. <br /> Q <br /> r77TN <br /> ...... ... ... <br /> Pk : <br /> � <br /> .... ....... <br /> .. <br /> . ... ........... <br /> .. ........ c . ..... ...... <br /> ..... .... ��. ..... ..... ...... <br /> .... ....... <br /> .. <br /> .... <br /> . . :..... <br /> ..... ...... <br /> ,.. <br /> •...:.. oto <br /> 1 0199fi <br /> ...: 05: <br /> rC ��ALS ant <br /> �iFiFdIt1t�hi h i <br /> 1 <br /> .. Ii+J CJ <br /> ... .,. <br /> FOR DEPARTMENT USE ONLY <br /> PLICATION ACCEPTED BY DATE: L AREA:a�� <br /> V;. RNSPECTION BY11A O E ! 1 HNAL M9PECTION BY DATE ! <br /> BION L ME S- <br /> MCOUNTNG ONLY: ASAI FACE <br /> PE CODE FEE INFO AMOUNT REMITTED CHIC,(CASH RECEIVED BY DATE SR I PENN"NRSAOER INVOICE/ <br /> Z f zSG� 1� Iafla 03 0 <br />