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I <br /> F <br /> F,l <br /> APPLICATION FOR UOUfl)WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> i ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)4663420 <br /> 14ON-REFUNDABLE PERMIT EXPIRES F YEAR FROM DATE ISSBFP <br /> lComplata In Trlplkat-I <br /> APEUCATION FB HEREBY MADE TO THE BAN JDAUUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE MW DESCRIBED.THIS APPVCATION IS MADE IN CUMRUANcE WITH SAN <br /> JOACUIN COUNTY OEVELOPMENF TMTALE CHHAP�TER 9-7110,3 AHD'i STANOARDS OF SAN JOAOUIN COUNTY RJOUC HEAL114 BEN�JVICCEa.EE'N�V MNMENT/AyLAHEALTH DIVISION. <br /> JDS APORESS/DR APA/ v✓/ �� � 1 �E✓ '�' ll�l Q _CITY /', fl/V 4� !�J le LOT SIZE <br /> OWNER'S NAME 1//LI7^.�•�rr[r/�CJCi'��✓ _ADDRESD +QLKfT/ti E- a rbt-(PHONE <br /> F,` <br /> R CONTRACTO ��.G =G�LL'r1[l' __ADDRESS �Q UCY 1,�S1Jf PHONE 3 <br /> SUB CONTRACTOR ADOREE6 -Uc. FHONE <br /> TYPE OF aEPTic WORK: NEP!INSTALLATION l8 REPAIMADVITIOH 11DFETRVGTION❑ l <br /> { ANO SEPTIC SYSTEM 54ENIMED IF-B4TC—A iZ AVAILABLE WITHIN ZOD FEET Or BVILdHo.7 FSiC TESTNI 1 I Now MANY <br /> AW-d..i <br /> IHBTAG TION WILL SIPVE RESIDENCE J4 COMMERCIAL DTHM Q <br /> NUMSER OF WINO UNITS: Nmam GF pFORDOMOr f NUM6Ht OF OAMOVEEA: <br /> CHARACTER OF SDIL TO A DEPTH OF O FEET: //PITISUMP SOIL CHARACTER: WATER TABLE DEFTM <br /> SEPTIC TANIVOIOLSE TRAP ❑TYPE.FG�� r�/ _CAPACRYTA _ NO-COMPIWTMENTB <br /> PRO TREATMENT PLANT❑ plSTANCE TO REAIMAT: SPELL T FOUNDA7IDN^7 F'7^ PROPERTY UNE <br /> UFT STATION❑ SI�ZE TYPE OF RUMP �+,,/'.T BAND OIL SEPARATOR(ENCLOSED BYBTEMI <br /> Up � <br /> LEACHNO <br /> NE 'i" No.►EENGTH OF MES ` CJI✓ DISTANCE TO NEAREST:WELL FOUNDATIONjCr, PROPERTY UNEP <br /> FILTER BED 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFDVNDATWN PROPERTY UNE <br /> MOVIMDED ❑WIDEN LENGTH DEPTH DISTANCETO NEAREST:WELLFOUNDATION PYOMIrLYUHE <br /> Fl; .EVADE NTA ❑DEPTH 147E NUMBER We ANCE TO NEAREST:WELLFOUNDATION PDOPERTY LME <br /> BUMPS ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY ONE <br /> DISPOSAL FONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOVNDATION PROPERTY UNE <br /> r HEREBY CERTIFYTHAT I HAVE PREPARED TMS APPLICATION AND THAT THE WORK WILL M DONE IN ACCORDANCE WTRI SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> AND REGULATIONS OF THE BAN JOAQUIN COUNTY.HOME OWNEROR LICENSED AGENT'S SIGNATURE C ERTIFIESTHEMOMNOI'ICEFMI THATINTHEPCR MAHCEOF TMEWDPKFORSWSCH <br /> !!! THIS PERMIT IS ISSUED,I SHALL NOTEMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME BVEJECTTO WUFKMAN'B COMPENSATION LAWS OFZALIFORNM.'CONTRACT'"NINNO OR <br /> SVS-cONTFACTIkG SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WCPK FOR WHMH THIS PERMIT IB ISSUED,I SMALL EMPLOY PERSONS BUSIEST To <br /> i WOWMAN'R COMPENSATITIO/ONN'LAWS OF CAUTORNIA.'THE APPLICANT MUST CALL 24 HOUSE IN ADVANCE FOR AMR ALL REQUIRED INSPECTIONS.COMPLETE d WINO BELOW. <br /> X lis <br /> . SIOHEP p�� �� _ TITLE: Y ���-.�1(Z/' DATE: <br /> PLOT PLAN..TO SCAIE3 SCALE' '1� <br /> 1,NAMFB DE STREETS OR ROADS NEAREST TO OR BOUNDING THE PROP FTI . 4.LOCATION OP HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2.OVTUNE OF THE PROPERTY.WITH DIMENSIONS MID NORTH DIRECTION. EXPANSION OF SEWADE 0IHPOSAL SYSTEMS. <br /> O.DIMENMONEO OUTLINES AND LOCATION OF ALL EMSTING AND PROPOSED STRUCTURES. S.LOCATION OF WELLS WITHIN RADrt16 OF ONE HUNDRED FIFTY FT.ON <br /> Fli <br /> INCLVdNO COVERED ARE.AB SUCH AS PATIOS DRIVEWAYS AND WAUCS......a - :.... o..,,:.. .s.. .-.. ..,,..:. <br /> i <br /> .... ...... <br /> .... <br /> ............ <br /> ............. <br /> .............. ....... ...... <br /> ............ <br /> A .. .. - _ _-.._ <br /> ............. <br /> I I d. <br /> ............. <br /> .......... ..... <br /> .............. ......... <br /> .G <br /> ......... <br /> ............ <br /> +, l LFI <br /> ............... <br /> ....--. .:... .. ............. ............ <br /> ...o.. _ ...LLL%%% ...,,. ...... .`ti�� <br /> ................ <br /> a s' "�L. ... ........... .... <br /> ............ <br /> .... ...... <br /> ..:_ 2 . . . .:... <br /> I , . <br /> :.. ... <br /> _ Y <br /> r <br /> � <br /> r ...... .. ... .. PUBL7C'HFALTFI SE L'E ..- <br /> ...... <br /> ............... <br /> .... <br /> .......... <br /> MR. ApTM—VSE ONLY <br /> - APPLICATION ACCEPTED BY i1 DATE: AREA' <br /> F JJJ TANK,PT OR SUMP INSPECTIO94 SY ! SINAL DATE `J <br /> ADDITIONAL COMMENTS: <br /> 3 ACCOVNTNO ONLY: MDA FACT <br /> PE CODE Mina I AMOUNT IiFMI1TED CISFD ticMH RECEIVED ST D-ATE Sx IPEfYAIT xI1MSDi INVOICE♦ <br /> Pub.HBaM SaN.•ERvIrD.174(3/96) ' <br />