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APPLICATION FOR Liam WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> Ld <br /> 6LEPEIINIE EMIIFE 1 YEAR FROM DATE ISSUED <br /> �/ 1 RlCeamPIETE IR TFilat4l <br /> ATIOX 1Y MAGE 1 W JOAOVN COUNTY FOR A PERMIT TO CONBrRC'r ANDMR INSTALL THE WOW DESCRIBED.TWO APFUCAT—H M MAD[IN COMPUAWf WITH MN <br /> Co, bEVEI.OPMEM CNIAPfER B•111/3 AND THE STANDARD*OP OAX/AAa11N COUNTY WM1C HEALTH OEIMCEE,EfNE1OMlNTAL MALTH DIVISION. <br /> AO ADORES. A.1lP � .44[ / CTY ��-G IAT S4E <br /> OW HER'■NAME ADORES. FNOME <br /> CONTRACTOR ADORES$ UCP PHONE <br /> "a CONTRACTOR ADDIESS LCS PHONE <br /> TV"OF SEPTIC WORK: NEW INSTALLATION❑ WAIIVADOMON❑ OD*TIUCTION❑ <br /> NO ffrM SYSTEM PEIATTEO N PVSIJC SEWER ID AVAIABLE WITHIN 200 FLET OF SUILDI NO I PSM TOXIN[!HAW MANY <br /> INSTALLATION WILL SUPE: IEOODENCE❑ COMMERCIAL❑ OTHER❑ <br /> IItAw DI OF LMNG ISfTS: FIIAISS91 Of BFDIIDOMO� NUMNISR OP YAPLOYRS: <br /> CHARACTER OF FOR TO A DEFrH OF!FEET:_ RTRUMEP SOIL dIAKA.CTER: WATER TANLE DEPTH <br /> SWI M TANIIIRGASE TRIP ❑WF A.011 CAPACRY NO.COMPARI'EN T <br /> PRO TREATMENT PLANT❑ DISTANCE TO EEAIE.LT: WELL FOUNDATION PROPERTY LINE <br /> LFT STATION❑ NE TYP'!OF ANAP SANO OIL SEPARATOR ENCLOSED SYSTEMA <br /> LEACHING UNE ❑ NO.A LENGTH OF LREB_ DISTANCE TO NEMER:WELL FOUNFiATIDN PIIOPERIY Ll1E <br /> FILT6f BED ❑WDTII LEWTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION P"DPERTV UNE <br /> MOUNDED ❑VYDTH LENGTHDER" 04 ACt TO NEIUEFT:WELLFOUNDATION P"OPPKTY LIVE <br /> SEVAOI PR* ❑OWM SIZE _WPM99A INSTANCE to WAFFFT:WELL FOUNDATION PMPEITY LIN[ <br /> BWPi ❑WIDTH LENGTH _DEPTH DISTANCE TO NEMERELL A <br /> :WFOUNDATION IOPELW_ <br /> L <br /> DISPOSAL FOND* <br /> ❑WIDTH UMTH CFPTYI DIFIANCE TO MEANEST:WELL__FOUNDATION PPOTERTY LNB <br /> 1 NFIEBY C! T"AT 1 HAVE PFEPAED THIS ATION AND THA:THE WOFR WILL BE DONE IN ACCORDANCE WITH SAI AAOUN COUNTY OHIRMAIRYS AFD STATE LAWS,AND IMUS <br /> AND REOUTA TIIEWI JOAOUNC HOME OWNER OR LICOI"D ADLHf`O wGMATLl1E CERTERS THE FOLLOANO:'1 CLRTIFYTHAT N THE PEMOIMIANCE OF THEWOIK FOR WHICH <br /> THM F[2MR M NOT EMPLOY PFRSON N NCH A MA#*ER M TO"COM[SUSXCT TO WOREEWXS COMPENMTION LAW*OF CALPKMdA.4 CONTRACTOTS HOWA OR <br /> SIONA <br /> CERTIFIES TM :Y CERTIFY'THAT N THE PENEORIMANCE OP TI*WOFK FOR WHICH THIO PERMIT IS ISSUM,1 MIALL EMPLOY PFRSOMF SIMIECT TO <br /> WOIKMAN'S T OF C TER APRJC T.1 CALL N EDW IN ADVANCE FOR A11wOUMM HIS/OCTIONO.COM FUM DRAIMHO BELOW. <br /> '151, r <br /> SIOXED% ' TITLE:_ <br /> PLOT PLA FAIAW To Bf.JLLE]SCALE _•1e <br /> 1.NAMES OP STFEETO OR ROAD* SMT f TO OR SOUNDITHE PROPCRTY. 4.LOCATION OF"DUN SEWAGE DISPOSAL.SYTTEM OR PROPOSED <br /> 2.OUTLIES!OF THE PROPEITY.WITH DIMENSIONS AND NORTH DWCTION. EXPANSION OF SE'WAOE DISPOSAL SYSTEMS. <br /> 3.DIMENSIONED OUTLIES AND LOCATION OF ALL"ISTNO AND PFIUPOSM STRICTURES, S.LOCATION OF WELLS WTfHIED M RADIUS OF ONE HUNDRFNTY FT.ON <br /> INCLUDING COVEEp AREAS SUCH N AND PATIOS.DM%MWAYS.AWALKS, THE PPMMRTY OR ADJOINING PROPERTY <br /> .. <br /> . .. . . . . ..... .. .. . . . <br /> 21 <br /> .............. <br /> :. . . ................. <br /> S <br /> c� <br /> :...:. ..:. MAI11 . <br /> .......:.... . .... 1 .. . .. ... ... ...... ..JAK J::ADU SaUv lY <br /> PU&1C HEAT, EA ICES <br /> . .... __ . .. .. ... ............ . ENVIRONMENTAL HEALTi 0IV,,ON <br /> P *OAPRNpr VBS OFPLY C f [/`o <br /> APPLICATION ACCEPTED B, A Ai DATE: d `t AMA: T <br /> TASK,FIT OR BUMP M"CT1DIP BY DATE ! I FINAL INSPECTION BY DATF N 1 <br /> ADMIONAL COUMFYTS. <br /> ACCOUNTPNG OIRY: ADS FACT <br /> PE COO[ FEENFO AMOLINt P&AN11TIM, IMC ASM TIBC.Or DATE M N—T NI-- INVOME F <br /> Pub.HBafth SONY.-EDWO.174(3198) <br />