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- s PLICATION FOR LIOUIO WASTE PERMIT .r <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION pt(( <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 V/ <br /> (209) 468-3420 <br /> 10N"RETONOAOI[_LEA IT EXPIRES I YEAR FROM URTE 198UED <br /> ICBmplotO In TTlplkBtq <br /> APPLICATION IB HEREBY MADE TO 114E BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDrOR INBTAI L THE WOR(DESCRIBED. THIS APAJCATION IB MADE IN COMPEANCE WITH BAN <br /> JOAQUIN COUNTY DEVELOPMENT TRUE,CHAPTER/91-1/11100.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PEBUC HEALTH GEEFMCEB.ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDRESSMIR AM'' / <ae � / !'1 L/F��+�L�/T P-rl • /� I 'C" Yrs //A� LOT SIZE <br /> OWNER'8 NAME TF�LYFC ADORES. P0-B/jE��K gj9�/0 wf S' L��V150�`��11A (MON y/�)� 2 , <br /> CONTRACTOR VA14-P4 A6 1�! EEAW / AODRE66�•V , OigX! ! - 4 P K�VL UICF R10NE " A4/ <br /> SUB COER"CTOn ADDRESS UC/ MONT <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPNR/ADDITION ❑ DESTRUCTION ❑ <br /> INO SEPTIC SYSTEM PERMITTED IF PVSUC SEWER IS AVAILABLE WITHIN 200 FEET OF SURJMNO.1 PEILC ESSEN)I//I HOW MANY <br /> bWla.Son• E�� <br /> INSTALLATION WILL SERVE RESIDENCE❑ COMMERCIAL ❑ OTHER ❑ <br /> NUMBER OF"NO UMTS:_ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES T""✓�.E..\`� <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: RT/BUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> SEPTIC TANIUCREASE TRAP ❑TYPE/MFD CAPACITY NO.COMPARTMENTS 1 <br /> PXU TREATMENT PLANT❑ DISTANCE TO NEAREST: WELLFOUNDATION PROPERTY UNE <br /> LIFT STATION❑ SIZE TYPE OF PIMP SAND OIL SEPARATOR(ENCLOSED SVBTEMI <br /> LEACHING UNE ❑ NO.B LENGTH OF LINES DISTANCE TO NEARESh WELL FOUNDATION PROPERTY UNE <br /> FILTER BID ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> MOUNDED ❑MOTH UNGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PEVFEHTV UNE <br /> SEEPAGE PTS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PERGPiRTY UNE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> DISPOSAL PONDS ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PIIOPERTY LINE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOR(WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER ORLICENSED AGENT'SSIONATURE CERTIFIESTHE FOLLOWING:-ICEITUFVTHAT INTHEPERFORMANCE OF THEWORK FORW N <br /> THIS PERMIT 18 ISSUED,I SHALL HOT EMPLOY ANY PERSON M BEACH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONEIRCTOR'9 HIRING OR <br /> SUB LOM ACTINO m URE CERTIFIE N FOLLOWINO:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT 18 ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMP A ION lAWB 0 ALIF RNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. <br /> elONEO% TEE /�/�C DATE: <br /> ROT N(DRAW TO SCALE)SCALE 11Ala <br /> L /Y%jam <br /> 1. NAME$OF STREETS OR ROADS NEAREST TO OR BOUNDIN THE P10PERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PHOIOSED <br /> 2, OUEUNE OF THE PIOPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DHIIVSAL SYSTEMS. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PRO(OSED STRUCTURES, 6. LOCATION Of WELLS WTTH)N BADGES OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAB SUCH AS PATIOS.DRIVEWAY&AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> N <br /> ,A <br /> // wy <br /> GEF <br /> - - ,¢JBIMP LOLATIOAI <br /> MAaaa irA <br /> N <br /> w _ . <br /> PAYMEN-1 <br /> RECEIVED <br /> SEP 14IM <br /> SAN.JOAOUIN CJUN;Y <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION �— <br /> r`— <br /> FOR DEPARTMENT USE ONLY <br /> LIZ <br /> AMICATION ACCEPTED By_�C�V�'EA'a I'CJ�I L�^'L y`- DATE: I AREA S <br /> TANK,PT OR SUMP INSMCTIO14 BY n <br /> DATE / / FINAL INSMCTION BV DATE 7 <br /> ADDITIONAL COMMENTS: I, Z. WL. ) -e,7 y 1" /In <br /> r <br /> ACCOUNDNO ONLY: AID' FACE <br /> R CODE FfE INFO NMOUNT REMIITEO CIIECIV ASH RECENEO BY DATE 6Rr P60.11T NUMBER INVGICEI <br /> Pub.Health Sery.�Enviro. 174(3/96) <br />