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APPLICATION FOR LIQUID Y� PERMIT <br /> fP '� SAN JOAQUIN COUNTY PUE1"HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION GJ <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOM• EFUNDARLE FFAMIT EXPIRES I TERN FROM ORiE ISSU D <br /> MompIite In TrlpUntE1 - <br /> APPLICATION 18 HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCMBED.THIS APPLICATION in MADE IN COMPLIANCE WITH SAN <br /> JOAOUIN COUNTY 1)rmopMENT'1TTT^�LFJ.CHAPTER 9-11110..3 ANO THE STAND'AAPID OF SAN JOAOVIN COUNTY LIC HEALTH <br /> fSERVDCCE/S,�ERON <br /> ENNVILIENTAL HEALTH DIVISION. <br /> JOB AMIRESS/OR APHS_J�-L l O V`'' Is�sT+•y! C! ___�j CfTy / /UTTt- __LOT B"", <br /> `T ! ADDRESS MMNE�©7—�f�Q 1 a-7-3OWNER'S NAME L//I/ � CJ�y/., /'.[L <br /> CONTRACTOR. AA0 P-Ta�! -'�-Y'"C. ADDRESS 4� G `-� •�I JI Y LACI / u .PHONE <br /> SUBCONTRACTO0. AGGRESS MF PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION RFPNRIADd110N❑ DESTRUCTION❑ <br /> WO SEPTIC SYSTEM PERMITTEO If PUSUC SEWER W AVAILABLE WITHIN 200 FEET OF BUILDINOJ PFRC TFJ171+1[1 HOW MANY <br /> /f APNrtlow I <br /> s L//�• <br /> INSTALLATIOx WILLSONE: RIESIDTNCE❑ COMMERCIAL� OTHER❑ CLQ "W'F'/ v,�L-S !U �y0_ <br /> TS: Nwout <br /> NIIMe�nEl OF W F WHOTSO A FEET OF■EDIWOMi: PRTTBUMP SOIL CHARACTER: WATER TABLE DEPTHX/utSASE TTUU' ❑TYI'EIh1 --'CAPACITY � NO.COMPARTMENTSMENT PLANT❑ INSTANCE TO NEAREST: WELL es _ FOUNDATION So PROPERTYVNE 1195� <br /> UFT STATION❑ WE TVFE OF PUMP SAND OIL SEPARATOR IENCLOBED BYSTEMI' <br /> LPACMNG UNE NO.8 LENGTH OF LINES O ,�' 5 DISTANCE TO NEL NEAREST,WELL FOUNDATION/490 PROPFxTY LINE _ <br /> FILTER SFO ❑WIOTH LENOTH DEPTH INSTANCE TO NEAREST:WELL FOUNDATION PROPERTY CNE <br /> MOUNDED ❑1MOTH LENOT14 DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> SEEPAGE RTS 11 DEPTH 812E NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTYUNE <br /> SUMpi Cl WROTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL PONOS LI WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WEU- FOUNDATION PROPERTY UNE <br /> 1 HEREBY CERTIFY THA71 HhVE PREP D THIS APPLICATION;.Fl <br /> H E WORK WIM BE DONE M ACCORDANCE WITH SAN JOAOWN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND AEOlRA710N8 OP77fESAN JOA IN COUNTY.HOMEOWNEN AGENT'S BNHLANRE CERTIF1Ee THE FOLLOW11N0:'10ER71F1rTHAT LATHE P:RP01aSANCE OFTHEWOPK FORYYIBCH <br /> TMB ISSUED,1 NOT RAY ANY PERSON IN MAN AS YO BECOME 6 TO WOWMAH'B COMPENSATION LAWS OF CAIJFORMA.-CONTRACTOWS HIRING OR <br /> NTRACT SIONAT C FOLLOWING: 1 E OF THE WORK FOR WHICH THIS <br /> PERMIT I6188ULp.I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORE AN'S Co TIO WS RMA.' THE T Mut CALL 31 NO.M ADVANCE FOR ALLIxSpEC710NiAVVNO.COMPLETE ORBS7EW <br /> LOz <br /> STONED TffLE: DATE: <br /> ROT PEAR IDIRAW TO SCALEI BCM.E 'I- <br /> I <br /> NAMES Of STREETS OR ROADS NEAREST TO OR BOUNONO THE PROPERTY. 4.LOCATRDIl Of HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSEDC <br /> 2.OITUNE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. - FAPAHISPN OP SEWAGE DISPOSAL SYSTEMS, <br /> 9.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTUMS, 6.LOCATION Of WELLS TMFFNN RADIUS OF ONE HUNDRED FIFTY f7.ON <br /> RJCLUDINO COVERED AREAS SUCH AS PATIOS.DRIVEWAY@,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> to ,PAY'S <br /> . <.. <br /> R , <br /> ... .... '..... d <br /> 1 <br /> - . 1998::: <br /> .. 3 <br /> Ls.4L1� u,v ; <br /> --. TO..=a -- \ E'NGIRONME 7gt!1 E c <br /> N R1' <br /> I ON <br /> . . .. ....,,,, .. <br /> Dr`s .......... <br /> t loi s� ..... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED SY DATE: AREA: <br /> TANK,PIT �ATEFOR SUMP NSPECTIOH BYFINAL INSPECTION SV ATE S! /A , <br /> 98 <br /> ADDITIONAL COMMENTS �y <br /> I ACCOUNTING ONLY: AW FAC, <br /> PE CODE FEE INFO AMOUNT 1LUMITEo CIIECIU Sex RmISVED BY DATE SR I FLSWeT Nu1NBNR TNYOICE S <br /> PUb.KeAIDI SSW..ERviro,174(3/96) 7-:5 0 <br />