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Jin n.la� API -'4TION FOR LIQUID WASTE PERM' /ACJ"1 G SAN J N COUNTY PUBLIC HEALTH SERVICES j �3—� ER QNMENTAL HEALTH DIVISION P.O.BOX 388, 445 N.SAN JOAQUIN ST.,STOCKTON,CA 952010388 (209)468.3420 "'- RON REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ICompkft I.Tniplfamtel is rude in Madetn is hereby rude to the Sen Joaquin County for a permit to construct end/or install the work described. This application is cmgrl fence with Sen Joaquin County Development Title, Chapter 9-1110.3 and the Standards of San Joaquin County Public Health services, Environmental Health Division. /, Job Adtlreae/or APNN W -752� / / / City �r Lot St.. JJ(,� Owner's NAAM)L -met T 46�b//i-a Address/�C ) / 6hL ve Contractor��j 1�� riY� -/ JZ-2 c� •.•fenLic7 Address_ _ N/ //�p)to�Trp Z/ Sub Contractor Address Lich Phone TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRIADDFEION I I DESTRUCTION I I PERI TESTIN 11 Naw eery (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEVER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) S � lad Uta AppRmtNa I 'v,7 ✓ Installation will serve: Residence_ Cmmercial_ Other_ ///1�/)Jyh oP^ � t` 7F / /i Muter of Living mita,_ NUEer of Wdrouw:_ Number of scptoyeear_ f— /i Ct-77y� - Character of soil to Is depth of 3 feet, Pit/Sup Soft Character, laterTableDepth SEPTIC TANWOREASE TMP 13 TYpa/Nfs CapacltY No. Compartments_ PND TREATMENT PUNT ( ) Dfetance to nearest: Wall Foundation Property time LIFT STATIONLI Site_Type of Pup_ Send Olt Separator (e�ncRlJLee SpLtE�p(�— LEACHING UNE 11 No. L length of Linea Distance to Nearnt: Welt_ FortN-W�It,1nYV�, C prapert`" ➢ y Lfna FILTER NEO ❑ Width_ Length_Depth _ x Wait_ Fat+NN�O!E�Fa9tF-•�V�7t(gopertY Line MOUNDED D Width_ Length_Depth_ R x Walt_ Foypp'Li,n J 13 kgrrty Line SEEPAGE PITS 11 Depth_ Site_Num"r_ " " Wall ybv. (tyi' 'LIN(..Ulp1'1 T t Lim tI Ir NP,,VPCR.Y SUMPS ❑ Width_ lmg[h_Depth_ + x WeIL VI°'�IOil -FpWFvC7MV�.AfbiV_i'IEn_1 t(let4Y Lim DISPOSAL PONDS D Width_ Length_Depth_ x x Well_ Foudatim_Property Lim I hereby certify that 1 have prep red this application and that the cork will W door in accordance with San Joaquin County Ordinances WW State leve, and pules and Regulations of the San JDaquin County. Marc turner or licenced agent's signature certifies the following "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such a esmer as to bee. subject to workmen's compensation laws of California. Contractor's hiring or Sub-contracting signature certifies the fallowing: RI certify that in the performance of the work for which this permit is Issued, I Shutt employ persons subject to workemMs Cmpensation laws of california.s TM ypUttat oust sell 24 hours in adverse far all required —Nayp,tis . /Complete,drawing below. Signed X ��! l �� /el �/ TYi PLOT PLAN (Draw to Scale) Scale_• to 1. Names of streets or roads merest to or briding the property. 4. Location of house sewage diapaast aYustee or 2. Outline of the property, with dimensi one and North direction. proposed expem fan of sewge disposal systems. 3. Dimensioned outlines and location of all existing and proposed 5. Location of wits within radius of 150 ft. on --tures, including covered areas such as patios, driveways, the property or "joining property. m G :A kF PARCEL t j vm..eo ...�.� Z en:Four 3 k LA a An' 6 to R.R. E --Y" '—'------- 6/a Mi uILe ROAD 2 KR! E F�� FOR DEPARTMENT USE ONLY (� APPLication Accept"by `4Z-D 1 'lam-P,fL >`_ Date: IAree: �y Tank, Pit or Sura Inspection by Data / / Final Inspection by-> r r ate I4 0 Additional Comment.: ACCOUNTING ONLY: AID# FACE PE CODE FEE INFO AMOUNT REMITTED EC CASH RECEIVED BY DATF SR I PERMIT NUMBER INVOICE I C;CZ