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l <br /> ` APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> �j ENVIRONMENTAL HEALTH DIVISION <br /> 304'E:AST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> {Complete In Triprastel <br /> F-ATION IB HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED. THIS APPLICATION 19 MADE IN COMPLIANCE WITH BAN <br /> ]AOUIN COUNTY DEVELOPMENT TITLE.CHAPTER 8-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HMTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. <br /> -7 �, /'���� t <br /> F'AD DPE6810RAPNI CITYLAT eRZE�i. �`y <br /> R'S NAME ` t i ADDRESS G PHONE U �Y� yj/�7 <br /> r <br /> DTOR,.A IJ PT 0AF �C• ADDRESS I r • •'�/ 3� !fC/ Y�G�' • PHONECONTRACTOR ADDRESS LIC/ PHONE <br /> f IPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRIADDITION DFATRIUCTION❑ <br /> KI SEPTIC SYSTEM PERM.]F ED IF PUBLIC SEWER IB AVAILABLE WITHIN 200 FEET OF BUI NO.) PBtC TESTI.)I I HOW MANY <br /> {`[ Appecsdm/ <br /> F."ATION WILL SERVE; RESIOENC COMMERCIAL❑ OTHER 1:1 <br /> LIMBER OF UVIOLS UMTB: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ol <br /> `A <br /> OF SOIL TO A DEPTH OF 3 FEET G'PITlSUMP SOIL CHARACTER. <br /> AN� WATER TABLE DEPTH �r <br /> SIC T E TRAP ❑TYPEIMFG C. �7+v CAPACITY !CP NO.COMPARTMENTS <br /> .O TREATMENT PLANT❑ DISTANCE TO NEAREAT: MIELL z� I FOUNDATION 16 � PROPERTY LINE. <br /> LIFT STATION© SIZE TYPE OF PUMP BAND OIL SEPARATOR iENCLOSED SYSTEM) <br /> I ``,, ff11 r <br /> `"NO LINE NO. Of LINES�`YD�r ri /T• DISTANCE TO NEAREST:WELLr�^FOUNOATWN�_PROPERTY 11Nf ICJ <br /> FER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERLY LINE <br /> OUNDED ❑WIDTH +� LENGTH DEPTLI DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> AGE PtteDEPTH /AS, SIZE NUMBER OISTANCE TO NUMBT: OO I POUNDATIION,/6, PROPERTY UNE l� <br /> ';iPB ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL. FOUNDATION PfOPERTY UNE <br /> or+OBAL PONDS D WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> iEBY CERTIFY THAT 1 HAVE PREPARE THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SMI JOAOUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> TION OF JOAOUIN UNTY.HOMEOWNER ORLICENSED AOENVBSIGNATURE CERTIFIEBTHE FOLLOWINO:ICEFMFYT14ATINTHEPERFORMANCE OFTHE WORK FORLMBCH <br /> �+ e e L NOT Y ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WO{KMAWS COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> i O B A IF S FO WINO:'1 CEF[trFY THAT IN THE PERPORMANCE OF THE WOFK FOR WHICH TMS PERMIT IS IBBUED,1 SHALL EMPLOY PERSONS SUBJECT TO <br /> D MAN'S C T N OF FORM THEJAKTTM ET CALL <br /> 22444 MOMS <br /> IN ADVANCE FOR ALL RECUIRED INSPECTIONS, COMPLETE DRAWING BELOW.. ](�J i/// <br /> + ^I X E V J J TITLE- I DATE:ST,3L Ir...i� <br /> L <br /> PLOT PLAN IDRAW TO SCALE)SCALE is <br /> TAMES OF STREET8 OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF{LOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> d �UTUNE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. - EXPANSION OF SEWAGE DISPOSAL SYSTEMS. - <br /> TMENWONEO OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATOR OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON SLI <br /> •INCLUDING COVERED AREA@ SUCH AS RATIOS.DRIVEWAYS,AND WAMS. THE PROPERTY OR ADJOIm10 PROPERTY. <br /> �. <br /> �..............>.... -- ... ..-..•. :. -........ _. ......�. .. .. - _ .. .. <br /> i <br /> ...._...... _1-� <br /> .......:......:...... ... ................ ....... <br /> ...........',....... ... .. .. . <br /> ..... ......;.... .... <br /> ....... <br /> ..... ....... ...... ...... ....... ...... <br /> [ i - - : p <br /> ........... <br /> ... .......... ........ .................. <br /> ............ ............................. <br /> ............. .... . <br /> .... ... .......... ...... ........... <br /> .............. ...... <br /> I ...... ,. .......... ., ,.... .... ... <br /> 1 <br /> ............. ........... ........... ...................... .. . <br /> `� QI <br /> : . .......... .. <br /> 777� <br /> o r3 .. <br /> .:....................:............ ................ <br /> ...........:......:...._:.......:... .. .. . ...... .......... <br /> ............................. <br /> ....... ....... ..... .............................. ............. <br /> ................ ...... .............. ................... ..... .. ..... ... ....... <br /> 1 4 ,�..:. . <br /> ...... ..D0 I .. <br /> ;................ ..... ... : l a ► . <br />