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AOUCATION FOR mum wASTE PERMIT <br /> SAtI JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 85202 <br /> -- (209)468.3420 <br /> MON-REFUNDABLE PERM %RE EAR FROM DATE ISSUID <br /> oNsTPU a M DIGR IN9t <br /> + APPLK:ATION le HEF¢BY MAGE TO THEM"JOAQUW COUNTY FOR A PEIiMR TO CONBT0.VCT ANDfO0.1NSFALL THE NIOIIL DESCRIBED.TN,B NTl1CAT1OM la MADE IN CDMPSIANCF WfiN 8!W <br /> 'i JOAo"COUNTY DEVELOPME <br /> ENyNT TITLE.cNAPFER 9-1111100.3 AND THE STANDARDS OF BAN JOAOUIN OOUMVUBLIC PHEALTH 6ERVI:EB.�ENVIRONMENTAL HEALTH�DIWIBIDN. <br /> w. JOB ADOMSMA APN. 5J/ Oi tL�G/� �`� !e A COY— L:t4lW } LOT SIZE <br /> E l OWNER'S NAME /GP,e°1Mlll ADDRESS PAI <br /> } <br /> COMPACTORS /"6Li r'G`�.Ls7? ADOAES� � /AV <br /> t � <br /> SUB CONTRACTOR - ADORES If PHONE <br /> TYPE OF SEPTIC wovw: NEW INSTALLATION RWAIRAPpNPN❑ OFSTIIIICTION Q <br /> CWO SEPTIC SYSTEM FERIM"ED IF PUBLIC SEWER IS AVAILADLE WITHIN 200 FEET OF BUIL KHM.1 PAtC TESTN.11 I HOW MANY <br /> r ' APP.wtlen l <br /> WETA"TION MU SERM' RESIDENCE 0 CDMMERGTM O OTHER❑ <br /> ` IfUMS I OF WINO UNSTI:-----/ NNA891 OF SmI1008re: `- NUMBER PF SNROYFif= <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITIGWP SDE.CHARACTER: WATER TABLE DEPTq _ <br /> REPTIC CAPACNY /�J _ ND.COLIPAATMEHfB�.. � <br /> 1 WgTREANKEMPLA TRA► ❑TYFFNFO �_ FOIAMOATION2--- PROPERTYLWE <br /> } { PKG 7REIl7NNEXT PLANT❑ DISTANCE TO NEAREST: WELL <br /> _{l UPT BTATNIN 0 SIZE TYPE OF RlP �a SAND OSEPARATOR IEHCLOSEP SYSTEMI - <br /> LEACHIM LINE NO.•IENOTH OF LWES _/M. R— 6[!r�___ __OISTAEICE TO NEAiIEBT:WELT- FOUNDATION� PROPERTY LINE <br /> h FILTER am C]WIDTH LENGTH OlPFH DISTANCE TO NEAREST,WELLFOUNDATION PIOFERTY LME <br /> ` y MPLNOEP ❑WIDTH LENGTH IW <br /> PEPFH DISTANCE TO NEAREST:WELL FOUNDATION APEMYEIHE <br /> SEEPAGE PRS 0 DEPTH SITE NUMeto DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> amps 0 Wmnl LENGTH DEF H DISTANCE To NEAREST:WELL FOUMATION PROPERTY LWE <br /> DISPOSAL PONDS ❑wmrH LEHGTH DEFTN DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> 1 HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL M DOM IN ACCOROMCE WITH SMI JDAOVIN COUNTY ORDINANCES AND STATE LAWS,AND RWES <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY,HOME OWNER OR LICENSED AGENT'S SMNATURE CERTIFIED THE FOLLOWING,'I CERTIFYTHAT W THS PERFORMANCE OF THE WORK PORWHICH <br /> THIS PERMIT W ISSUED,1 tlMLL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORLMAN'S COMPENSATION LAWS OF CALSONOA.'COMPACTOR'S HIRING OR <br /> SUSCONTRACTINO SIONATIRIE CERTIFIES THE FOLLOWING:7 CERTIFY THAT P THE PEFWORLIAW A OF THE Vmw FOR WHICH THIS PERMIT R ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WOFKMAN'S COMPENSATION LAWS OF CALIFORNIA-THE APPLICANT MUST CALL 2E HOISTS IN ADVANOS POR�ALL R^EOMUM INAMMNS.COMPLETE PRAWNS BELOW. <br /> I}•�,[ SIONED x TITLE:-IF ----.Ff/1/T�- DATE: S� <br /> } ' PLOT PUN IPRAW TO SCALE)SCALE' -M <br /> 1.NAMES OP STREETS OR ROADS NEAREST TO OR WUNOWO THE PROPERTY. t LOCATION OF HOUSE SEWAGE EMPOBM SYSTEM OR PROPOSED <br /> S. ENB <br /> OURINE OF THE PROPERTY,WITH THMENSIONB MND NORTH DOFC DON. EXPANSION OF SEWAGE DISPOSAL SYSTEMS, <br /> 3.OIMONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, E.LOCATION OF WELLS NGTNIN RADNS OF ONE HUNDRED FIFTY MON ' <br /> . MLUNNO COVERED APE"SUCH AS PATIOB.DRIVEWAYS.AND WALED, THE PIOPERTY OR ADJOINING POPERTY- <br /> r i .... <br /> RI ...... ............ <br /> ... . .. .. ..... ,. .. .... ..- <br /> ¢.,..... <br /> k3._ ... . ...,......., <br /> I (Zur r <br /> .. ,� <br /> .. .::.. <br /> - . <br /> . -- � <br /> JL <br /> YMENT <br /> - I1lY 1 h8 <br /> ... --' yRT/3 pI ICUUINTY <br /> .. .... .. <br /> m r <br /> ATd JOAN <br /> _ ,.._PL]SIJCNEAL N'SEF+11GE5.... <br /> POR DEPARTMENT USE ONLY ' <br /> i - APPLICATION ACCEPTED BY / GATES <br /> +T` TANG,PF OR SUMP INSFECTONFWALSP <br /> INFCTON BY 'DATE <br /> AOUIHONAL COMMENTS: <br /> ACCOUNTIMO ONLY: MDP FAC. <br /> J PB CGDE FEE INFO AMOUNT IL ITED CHIC ICASH RECDYID By PATE iR I-POW"IRBA861 IN ice# <br /> 0167,111 <br /> 1 <br /> I Pub.Health Serv..ErrAro.174(3186) <br />