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APPUCATION FOR UQUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 4 <br /> 304 EAST WEBER AVENUE,STOCKTON, CA 95202 n\� <br /> ^1 (209)468-3420 <br /> U NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> N:BBgMU In Tr4UaRl <br /> APPLICATION 16 HEPERY MADE TO THE BAN JOAGIIIN COUNTY FOR A FEMR TO CONSTRICT ANDMA NST TW WON(DESCRIBED, THIS AP ATION 18 MADE IN COMPLIANCE WFTH BIW <br /> ,IOAOUIN COUNTY DEVELOPMEM TILE.CNAPTEIR 9-1 V.13 AND f1E M OF BAN JDACUIN COUNTY N HEALTH SERVICES.ENVIIgNMENTAL HEALTH pWBION. <br /> JOB ADORE6BAR APN /^/ i P CRY �E LOTc9SIZ 4// <br /> ,EI, Jr P�4 Q _ngfn:� 6 '�Er d <br /> OWNER-9 NAME - Y H I i'1-(.� ADDRESS <br /> CONTRACTOR 90 T'T-�oIv (7I✓I£' S • AODRESs 7 �2."a�.� EIC) • �� '� PNDNE�6I TGE <br /> SUB CONTRACTOR Al%IRE88 IJCF P11DM <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPNNMdTION ok DESTRUCTION ❑ <br /> NO SE"K,SYSTEM PERW FFFM IF PUBLIC SEWER 16 AVAILABLE WITHIN 200 FEET OF BUILDING-1 FET--ill <br /> 1 I NOW MANY <br /> INSTALLATION WILL FERW RESIDENCE❑ COMMERCIAL ❑ OTHER❑ <br /> SUMMER OF EWNG UMTS:) NUMBER OF RESMOOIMS: 3 NUMBER OF EMPLOYEES: <br /> CHARACF SON. <br /> O A <br /> F 3 FEET <br /> FTH— <br /> SEPTIC TTER AN OBgREAFETTRAP H O❑1VPEAIF' Iv n A [FPy�IJTtHCAF TETE' > Q� WATER TABLE <br /> NODCOMPMTMEM6 } <br /> �J r✓� <br /> PXO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL /O d T FOUNDATION d PROF*HFY UNE. <br /> LOT STATION❑ 612E TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> —T: Yi <br /> LEACHING ONE ❑ N0.4lENOTH Of UNE6 /'LAG k 7L{E DISTANCE TO NEAREST:WELLJ.rin-L FOLINOATgN _fYgPERIY UNE E <br /> FILTER BED ❑WIDTH LLNGTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION fTcmE UNE <br /> MOUNOM ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> e®AOS FITS ❑DEPTH I S F ORE '21,. I, NUMBER I DISTANCE TO NEAREST:Y1ELL •FOUNDATION L� PROPERY UNE <br /> RUMPS ❑YMOTH LENGTH DEPTH DIGTANCE TO NEAREST:WELLFUMOAFON FRIFETYLME <br /> DISPOSAL PONDS ❑WIDTH UENGTN DEPTH DISTANCE TO MEANEST:WELL FOUNDATION PROVERTY UM: <br /> 1 HERESY CERTIFY THAT 1 HAVE PPEPASED THIS APPLICATION AND THAT THE WORK WILL Of DONE IN ACCOMANCE WITH SAN ,OAUUIH COMFY OR TINANCES AND STATE LAWS,AND RULES <br /> ANO RAUlATMHO OFTHE BAN JOAOUN COIMTY./TOME OWNER ORLKENSED AGENT'S MONATURE CERTIFIES THE FOLLOWN 0;'I CEATIFYTHAT INTHE MWORMANCE OF THE WOR(FOR WHICH <br /> THIS ER.IR N ISSUED,I SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION""OF CALIFORNIA,' CONTRACTOR'S HIRING OR <br /> `6UBLONTNCTM BR,ATUR,CERTIFIES THE FOLLOW,,,:I CERTIFY THAT N THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO <br /> WOIKMNI'B COMPENSATION LAWS OF CALIMFHb.' TIR NPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS, COMPLETE DRAWING BELOW, <br /> TILE: �lry Jy Trao�oT. DATE:%O- <br /> PLOT FLAN(DRAW TO SCALE) <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY, M. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PFKRF fY.WITH"MENOONG AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS, <br /> 3. NMENUONED OUTLINES AND LOCATION OF ALL IE NTNG AND PROPOSED STRUCTURES, G. LOCATION OF WELLS WITUN RADRIS OF ONE HUNDREO FIFTY FT.ON <br /> "- INCLIgINO COVERED AREAL SOON AS PATIOS.DRIVEWAYS.AND WALKS- THE PROPERTY OR ADJDNMNU PROPERTY. <br /> - _ I <br /> ... l�. <br /> tr <br /> ' 14 2 U <br /> .� OCT 0 199 <br />