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APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES— ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 445 N. SAN JOAQUIN ST., STOCKTON, CA 95201.0388 D (2091468-3420 r NUN�REFUNURBLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED IC$RIPYt$In Triplicate) APPLICATION IS HEREBY MADE TO THE SAN"AWN COUNTY MR A PERMIT TO CONSTRUCT ANDOR INSTALL THE WOW DESCRIBED. TNI$APRICATON IB MADE IN COMPLIANCE WITH BAN JOAQUIN COUNTY DEVELOPMENT TITLE.CUHAPTER 9-11100 3 AND/�T-HSE/—gyT EANDyAJRDg OFT am JOAQUIN COUNTY RIBUC HEALTH SMWEES,�E�NNVU90O/N(/ME�"MAL.HHEALL�TH NWWN. JOB ADDIE:BSOR AFN L O/F/•�[ /�� -�^• L`/ Jif L�-//Y��/�/ O- Cm 'C')L'LL'/ lAyy� K� LOT SIZE OWNER'S NAME /� ]'VT� �./.H T 1-E' / ADDRESS QIC�7 O.OI�I X/�•-,v/� '/� —� pHO L� 7 CONTRACTOR CS�TN iJ� Gl ' AODRE68 5A-(f • w<— EJCe C SUBCONTRACTOR ADDRE66 UKa PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ IEEPAUIMDITON ❑ DPSTIUCTON 0 (NO SEPTIC SYSTEM PERMUTED IF PUBLIC SEWER 16 AVAILABLE WITHIN 200 FEET OF BUILDING.) RISC TESTDI I I HOW MANY AppbSSen I INSTALLATION WILL SONE: RESIDENCE❑ COMMERCIALS OTHER❑ /L L� / AP < Q / NUMBER OF UNNO UNITE_ NUMBER OF BEDROOM$: NUMBER,Or EN,,OD J: 54.t, `"TS GSE y� '�'IZr� S`�JJTZ�r J 1-1 CHARACTER OF FOIL TO A DEPTH OF 3 FEST: PITIBUMP SOK CHARACTER: WATER TABLE DEFT) • SEPTIC TANKIOREA6E TRAP ❑TYPE/MFG CAPACITY NO.COMPARTMENTS PKG TREATMENT PLANT 11 DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 717A Q.IM UFT STATION❑ 61ZE TYLE OF NMP $AND OIL SEPARATOR(ENCLOSED SYBTEMI �pRECEIVED E C E I V E D LEACH ES NSTANCE TO ST:WEM_FOUNDATION FILTER BM 11 11 WIDTH LENGTH OF LENGTH DEPTH DISTANCE TO NEAP ST:WELL FOUNDATION I ISP V1 E L/ MOUNDED 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATON___SAptj 'IiNaCOUNTY SEEPAGE RTS 11 DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELLFOUNDATION PtIBLICPPA�d�T��Qab•LTJILNEACTIE } • ..J SUMPS 11 MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATQ VIRI) NWkO Tlq�p'I JWM "" 0174 DISPOSAL PONDS ❑MUTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE I HEREBY CERTIFY THAT I HAVE PREPARED TJFO CATION ANO THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIO F THE BAN JOAQUIN COUME WNER ORUCENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-I CERTIFYTHAT IN THE PERFORMANCE OF THEMW FORWHICH THIS PERMIT IB SUE )SHALL NOT EMPLON N SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUB-0ONTRAC IND BI ATURE CERTIFIES THNG '1CERTIFYTH 'IN THEPERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TOWORKMAN'S MPEN TIONLAWSOFCAUH APNCA UST CALL N HOURS IN ADVANCE FOR ALL REQUIREDII PECTIONS. COMPLETE DRAWING BELOW. ` EE.O ^1 9 BONED X TITLE 'V LI� DATE: ROT MAN(DRAW TO SCALE)SCALE—,tP 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2, OUTLINE OF THE PROPERTY,WITH D MENMNS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTUNE$AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT,ON 1 INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. EDGE OF SEPTIC TANK & SEPTIC LINES -- - — 17 7, 3" DRAIN LINE__. _. -- __ .-- - 22'- - { ---- 1 _.. — 7' FL=17.38 I 19.00 19.00 �., 12.5' I D i 4 FINISHED C SLOPE 1 CQNC, GRADE PEP, F. OT 0 r•i MULTI MEDIA PUL. FILTER. " —2 2 2' 1 1 2' -- - 41 DIA_ _ 2 3 I J 4 T P MP PRESS. 19.00 19.00 SYSTEM C.O. G.J tC/ OR Dd FLIT USE ONLY L� APPLICATION ACCEPTED BY J DATE: � ' I � AREA; 2 TANK,PIT OR SUMP INSPECTION BY DATE / / FINAL INSPECTION-B DATE I / Oo�r�A��..y, ,�� /f�P �•f%tdco. ACCOUNTING ONLY: AIDI FAC.I PE CODE FEE INFO I AMOUNT REMITTED QLr.P!/CASH RECDVED BY DATE SR I P NMIT NUMBER INVOICE B *2 114 / 9 3 S�