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:J19 n <br /> APPLICATION FOR LIQUID WASTE PERMfT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> �. ,' • ENVIRONMENTAL HEALTH OIYI810N <br /> SEPTIC <br /> P.O.BOK 388,446 N.SAN JOAQUIN ST,STOCKTON,CA 96201.OSU <br /> 12081 481.3820 <br /> NO&RHUNDABLE PEIBIR UMRER I YEAR FROM BATE 13890 <br /> 1GSIpfNL Y TrfPTehl c 1 f wi: <br /> APPlWCA710I E HERFY MADE TO THE SAN JOAOUN COUNTY FOR A PERMR TO CO%lFrM T ARMOR INSTALL THE WOIR MBCr4M'TKM APPUCATION Ni MICE N COMRIANCE Wm W0 <br /> .IDJIOISM <br /> COUNTY DIIJUAPEIFM TITLE,CHAPTER P-1 110.3 AND THE STANDARpDS OF SAN JGAOUN COUNTY PLIKPC HEALTH SEAM M EWAMMEMAL HEA&H Dh g64- - ,/ <br /> JOB ADWIVIBIPRAPPIr l�XI -FT:ew�uN ISE�IoTYr A!,} f.1aT�N.tiF ,, �iR7 De�J , ,401w, <br /> OWAEN'SNAME JavtX.I SIXL•REGl1 „DDI�Esa,� slti�Jr7E^�_��, 897.3�'7 <br /> LaMRAL'ras SI x u t to .._AODDEu 3,A'/PT c— LIrJI 3(o 378 S PRONE SINHt <br /> IRIDEOIORACIION At1 C AW t _ _ AGOREBO UCS FNONE <br /> Tm OF SEPTIC wow Naw INarmLATm RIP"NAO RMN Q D "WCTM Q <br /> WO SEFM SYSTEM PERMITTED M FURUC SEWER O AVA1L#SLR WRHOT 100 FEET OF BULOMG.I Nm TnTf.11 1"m Lum <br /> APPTIv.aen i� <br /> Mam"TOM WRL aEDVR rta@LHCE[5"' <br /> mAL f3 wmm Q <br /> NUIReDR OF LARNG INIITN: E MOMMIR OF I MWMWa: NUMSET OF IMPLOYia: <br /> CIWGCTER OF OOL TO A DEPTH OF 3 FFLET. ,PITBUMP BOL CHARACT WATER TAEER DEFTIT <br /> NNIRM TANKARGaa T11M LL7TYPEr]IMG eAFAefTY _ ., _ NO.CONPA11TMdlra L i <br /> PEG TMATATER PLANT E3 merANCE TB NwaaT, WTSL x 0 0� FOUNDATION' G 0 I PIOPU Try LOIS $a I <br /> LEFT ATATOIC E7 am TWE OF PUMP SMO GL BEPARA7UR ENCLMD MUM, r <br /> LEACHING LMNOL7 IIFlN1TN OF 111Ea, � OIarANCE IO NEAHEaT:RETE X00' FoLww- m 70' PwmrrY Lm �- <br /> RTNL M 13 warty u3dcm, pEPM NSTANCE TG wAri T:WELL m NGATTON TNWOPERY UIE <br /> MOMECED E3 WtVTH LENGTH_ DEPTH DISTANCE TO NEAREST:WEU_FOUNDATION PROPERTY UNE <br /> S®AGE PITH T�BrPrH x Jr' ' BRE ITZ77'­ <br /> NUMBNI_JL3 DIBTAFICE TO NEA ETR:WRU+� PJISOATTOH f z0' ►ROFERrY61NE <br /> aLRR WIOTN LENOTH__OUT' VISTANCE TO NEATEST:WELL,RAMATNWH PROPERTY LNE— <br /> DISPOSAL TOMOS 13 WAOTN LENGTH _DEPTH DISTANCE TO NEATEST M181„^_FOUNDATION FFOFETrTY UKE ' <br /> 1 HDEBY CERTIFY TNAT 1 HAVE PREPAMD TMS APPLICATION AND THAT THE WOM 1MLL W DONE M ACO MM 0E WITH SAN.IOAOUIN WW"00 MANCES AND STATE LAWS,AND MMES N <br /> ANDRIMULATION DFTHEBAN JOAO1aN COIMTY.NOMEOWI4ER ORIJCENBEOAOBTT'S BwxAn,rtcERTElEBTHE T011.OYYS/Ds 1CFATIFYTHA7Ix7HaPE1lOIWANCEOFTIEWGF"FORNRSCH <br /> TIO PERMIT IS tOSUED,I SHALL NOT E MMLOY ANY PERSON M RCN A MANNER AS TO SWOME SLEN[ZT TO WOMMAN S COMPENBATIDN LAYS OF CAUP"MA!CONTRAGTOWS himme OR <br /> NLDFCONTRACTMC SIGNATURE CERTIRES THE FOLLOWING:'1 CERTIFY THAT INTHE PESOItAAME OF TME WOTK FOR WMCN TMS PEM rF 48188L!®,1 MLAIL EMPLOY PERSONS S LNMT TO <br /> WORKMAN'S COMPEHBATq 01 CA1LIFONGA.'T! CMR T CALL"MOURN M ADVAMOE MR ALL IEa11B1®INSPE...COMpLrm DRAvwm BELOW. <br /> aRLI ED x CtJ uc -TITLE. D 1�x1�R _arae 71 r I <br /> nnr FLAx aTIMW 7G BCA:Fj acALE GS <br /> I.NANLN OF SREE'TB OR NOAOS NEAREST TO OR M BOUNDMG THE MWPFIITY_ tea.LOCATION OF HOUSE BEWAOE DISPOM WM OR FRIM6 D (O <br /> R <br /> E.OVTUWE OF THE PROPnY,YNR/OM4FNm NS AND MM1E OIRECTMN. ExPANMW OF 010WAGE DINPOaAL DYWEML <br /> G.DMENEEONM OGTLIIER Amm LOCATION OF ALL FOOTING AND"W"OSED STHJCTUMs' E.LOCATION OF WELLS WFn M RADRIB OF ONE HUMORED FIFTY FT.ON <br /> INCLDOM COVERED AREAE EUCX AS PATIOS,OWVLWAYS,AND WAIML THE PROPERTY OR AOJON PIQ PROPERTY. �. <br /> :......:......:. . ..... ... :.. . ..:........ <br /> ON JdA0t)j <br /> PU[3LEC I' . . <br /> N'LfpC.�NMgt�7A H VEC 4 <br /> EAL N DI1/iSlpp <br /> ' <br /> .Ore -.. <br /> .l . <br /> ..,,, <br /> .>.... ..... .. .......:.. ...: <br /> ........... ....... .... <br /> • - - - _ <br /> I Two <br /> ... ....:................... . ....... ......o ............... ...,,...... ...... ... ......., <br /> ..., ., ...... .... <br /> ... <br /> �r <br /> 370 <br /> FOR ODPANRuaT ITE aDLT �7 1 <br /> APntuTON ACCEPTED SV_ c OATS: AREA: <br /> TAMC,PR OR SUMP MSFECTTON PT DATE,. I Irk n F`NAL MSPECfTWN IR,Y DATE l <br /> ADORONx CONEMETTTB: NlagIrc ;— .m -wxA.LS•,Jee 5�C}c,xM�y Q'Y`A.i• � NE.0 S'e' Ak �4A AT <br /> hE 'Tom"N V a4 <br /> /R s <br /> AeeounD ONLY: Alw FACE <br /> NnP�4 <br /> PN COD[ FF111�0 AAAOUIIT C ASN RECYII10 aY DATE NR f PDYT NDSASEI NEVOOB F <br /> ao o 6c, <br />