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�! APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES tia:3u <br /> �•- ,rno�,.E-� ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> tejk,il` (w# -lom,4 Sid) (209)468-3420 <br /> I, <br /> r � K 1109-REFUNDABLE PERMIT EXPIRES t YEAR FROM DATE ISSUED <br /> 1 IC=pbts in TrIpfinnl <br /> I� 11 APPLICATION IS HERESY MADE TO THE BAN JOAOUIN COUNiV FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WO1K DESCRIBED- TNIB APPLICATION IS MADE IN COMPLIANCE WITH SAH <br /> JOAOUIN COUNTY OEVELOPJM�j�LF TITLE.CHAPTER 10-1110.3 AND T15 STANDARDS OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES. <br /> ENVIRONMENTAL HEALTH DIVISION. J) <br /> JOB ADDNNOR APNN v CITY !DT 82f <br /> Rffi1l�'t` <br /> PSF PHONE J ! <br /> OWNER'S NAM T rZ ADDRESS <br /> C• FlCI �PHONE <br /> jr � <br /> 3 <br /> CONTRACTOR../V'' <br /> 6U6 CONTRACTORADDRESS (ICI PHONE <br /> , <br /> TYPE OF SEPTIC WORK: NEW TNATALLATION 13 REPAMADOITION DESTRUCTION CI <br /> F M SEPTIC SYSTEM PEIwmEO IF P/BUC B£WER i8 AVAILABLE wffmm 2w FEET OF 8U .I PFAC TEST141 I I NOW MANY_ <br /> AyPMe+tlan/ <br /> INSTALLATION WILL SERV E: N IDENCEVCOMMERCIAL[3 OTHER 0 <br /> NUMBER OF YVINO UMITA: NUMBNR OF BEDROOMS: NUMBEIR OF IMPLOYR <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET PrTISUMP SOIL CN WATER TABLE DEPTH <br /> SEPTIC TANKI�tEABE TRAP 13TYPE/MFfl CAPACITY NO.COMPARTMENTS <br /> PKG TREJLTMFIMT FI.AMT❑ DISTANCE 10 NEAREST: WELL FOUNDATION PRDKRTY LINE <br /> LIFT STAMM 13 ME TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEMI r lQ� r f <br /> L.EJICMN4 LINE )NO.i LENGTH OF UTIEB <br /> Q r lna DISTANCE TO NEAREST:WELL/02Q I FOUNDATION PROPERTY UNE <br /> FFF FILTER Bm 0 WWTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOVNOLa- ❑WIDTH LENGTH DEPTH .DISTANCE TO NE& EST:WELL FOUNDATION'T'''PROPERTY UNE_' <br /> �� SQ PROPERTY LINE <br /> SUPAOE PITA Me � r,.,NUMBER_DISTANCE TO NEAREST: 2 � FOUNoAT10N - <br /> SUMS t3 WOM LENGTH DEPTH dSTANCETO NEAREST:WELL FOUNDATION PROPERI V LINE <br /> DISPOSAL PON" ❑WUm LIENGTH DEPTH DISTANCE TO NEAREST'WEAL FOUNDATION PROPERTY LINE, <br /> r <br /> 1 HERESY CERTIFY THAT 1 f AREO THIS APFLICA MIO THAT THE WORK WILL BE DONE 1N ACCORDANCE WITH SAN JOAGUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> ANDRMULATMMOFTHEfAN.fo COUNTY.I* OR LICENSED AGENT'SSKLNAWRECERnPFES7HEFOLL6WIHOi'ICERL7FIfTHAFIHTNEPE�D AHCEOFTHEWORKPDRWIRCH <br /> THH; ERMIT IB 16811ED,L SNAIL PLOY ANY PE#TSO BUCK A MANNER(AN TO BECOME SUBJECTTO WORKMAN'S coMFUMTION LAWS OF CALWONVBA.' CONTRACTOR'S HIWMq OR <br /> O. N CERT B THE POLL ERTiFY THAT M THE PERPOMANCE OF THE WORK FOR WHICH THIS PERMIT'IS TBSIIEl1,k SHATL EMPLOY PERSONS SUBJECT TO <br /> RaCLM "8 M T LAWS O A.' ANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED IESPECTIONS. COMRET7:DRAWING BELOW. <br /> GATE <br /> TITLE: <br /> SIT x <br /> LA <br /> PLOT PLAN SORAW TO 1kCAlE1 SCALE 'to <br /> 1. NAMES OFI so ADS NEAREST To OR MINDINO THE PROPERTY. 4. LOCATION OF MOUSE SLWAGE DISPOSAL SYSTEM OR PROPOSED <br /> EXPANSION SEWAGE DISPOSAL SYBTETYIS. <br /> 2. OUTTLINE OF THE WITH DIMENSIONS AND NORTH DMUTION. <br /> 3. DIMENSIO IED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES. 5. LOCATION WELLS N _ <br /> INCLUDING COVERED AREAS SUCH AS PATIOS.DIBVEWAYS,AND WALKe. THE PROPERTY <br /> Y OR ADJOINING PROPERTY. <br /> IN PRODS OF ONE HUNDRED FIFTY FT.ON <br /> ...-... .. <br /> .... .. <br /> ............i... ... :.......: <br /> ............. .. - . <br /> ...-. ...:. <br /> __ <br /> . ' .-.-.:.......-.-."..;......E.............:.......5......:..-.-.:.. <br /> : .... <br /> .. .. - - <br /> ..-i". ..:... <br /> : <br /> . . <br /> - <br /> : - E -. .. <br /> :.. <br /> <.... <..... .... . <br /> s.- '.....<... .. <br /> : . <br /> : . <br /> : ... ..... . <br /> ............... <br /> ......... <br /> .......... <br /> .......... <br /> ...:. {{ <br /> 14 ...... <br /> .".. - ... <br /> ..i----...E... s ............. -. .. <br /> .. ... - <br /> ..-:.."-..:......":"." <br /> ...... <br /> ....... <br /> .......... <br /> ............. <br /> F, ............ <br /> ..... <br /> ..... <br /> i .....so <br /> ....:.......:......:-. <br /> Y <br /> : <br /> Y <br /> : \ .. SEP <br /> - <br /> ... ... .................. <br /> ... .. ........ <br /> ............. <br /> ... <br /> ........................... <br /> ......:.......:..-....... .. ..:......'.-....a-. <br /> I :....._:.......:. ACUN... US[JGlf£A-T y <br /> :..............: '... . .....W1 <br /> - � � ..,• `�� ` � '-.�" ..-.;..- v......-....�...-�....._."...-.-.-.. ;.-. ...-.y....:.:...AOf�th+fENTAL .,.. .H.DIVIS +� <br /> .......;..............:-. - - _ - ..;......... A- a-...... .....;.--.-.... c ..E......r......E ....5..........._ <br />