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L,le)0 5-/ <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> --SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. sox 388, 304 EAST wEaER AVENUE, STOCKTON, CA SMI-388 <br /> 1209) 468.3420 DEC 1, SII <br /> 1998 <br /> YWK4FUNDABLE PERMIT EXPIRES I YEAPIROM DATE ISSUED <br /> {Complete in Tripikets) <br /> APPLICATION 18 HEAEBYMADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED, THIS APPLICATION 18 MADE IN COMPLIANCE WITH! <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1 1 10.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDRESSIOR APN# d07 - /ISO- 56 C rry A c-e-p"02 o LOT SIZE <br /> OWNER'S NAME-06 <br /> .. i-jl 4. Fe-rre,,'r.-- ADDRESS 373 W. Li,,&g-, /} fir. 8a, C-4 PHONE 16 00 <br /> CONTRACTOR l r, <br /> j6&j0­41,lEr l ODRES ev A _LAG--. <br /> SUR CONTRACTOR ADDRESS LIC# PHONE <br /> TYPE OF SEPTIC WOR INSTALLATION ❑ RFPAIR/AbbfTION C3 DESTRUCTION ❑ <br /> IND SEPTIC SYSTEM:: W <br /> RM2�ED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET Of BUILDING.) PERC TESTI]I I NOW MANY <br /> Alfce,l t. bc, Spli-,"- Appiloadonf <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL0 OTHER 13 <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS-- NUMBER OF EMPLOYEES; <br /> CHARACTER OF SOIL TO A DEPTH OF:3 FEET: j6rFl,,e(e PtTISUMP SOIL CHARACTER-. WATER TABLE DEPTH <br /> SEPTIC TANIUGRFASE TRAP [I TYPE/MFG CAPACITY NO.COMPARTMENTS <br /> PKG TREATMENT PLANT 1:1 INSTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> LIFT STATIONO SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM] <br /> LFAC NoLINE E3 NO.&LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> FILTER RED 13 WIDTH LENGTH_DEPTH_DISTANCE TO NEAREST*WELL FOUNDATION-PROPERTY UNE <br /> MOUNDED 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> SEEPAGE PITS 11 DEPTH-size NUMBER DISTANCE To NEAREST!WELL FOUNDATION PROPERTY LINE <br /> SUMPS E3 WIOTH_LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> DISPOSAL PONDS 11 WIDTH LENGTH-DEPTH_DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT t HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RUI <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:"I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FORWI41 <br /> THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING <br /> SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING,'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,I SMALL EMPLOY PERSONS SUBJECT <br /> WORKMAN'S COMPEN ATIO LAWCALIFORNIA.' HE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL RFalXRFD INSPECTIONS. COMPLETE DRAWING W. <br /> ,6�01`CALIFORNIA BELO <br /> SIGNED X_ TITLE: '5f� ff DATE: <br /> UPLOT PLAN(DRAW TO SCALE]SCALE <br /> 1. NAMES Of STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> I. 3, DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF%%Wl I '6 OF ONE HUNDRED FIFTY FT, <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS <br /> R7Y, <br /> C L L I E f? ROAD <br /> .......... <br /> PARCEL 2 <br /> _bvr,luo PARCEL I <br /> It <br /> ........... <br /> .......... <br /> ....................... <br /> i.............. <br /> AV-= D E 1998 <br /> SAJ. <br /> Puffi',.: <br /> ENVIRON <br /> VrINIrt M&P <br /> FOR D8PTTMENT USE ONLY <br /> �2 t <br /> APPLICATION ACCEPTED BY DATE: AREA: <br /> TANK,PIT On SUMP INSPECTION BY DATE' f IqSPECTION BY �CAATE <br /> I <br /> ADDITIONAL COMMENTS: "77 <br /> • FAlGlltfNG ONLY: AID# FACO <br /> PE CODE2- REMITTED HE !CASH RECEPW BY DATE FEE INFO AMOUNT REMIT SIR 1 PERMIT NUMBER INVOICE 0 <br /> A 652- <br />