Laserfiche WebLink
APPLICA FOR LIDUID WASTE PERMIT C <br /> SAN JOAOUIN' ITUNTV PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388, 44B N. SAN JOAQUIN ST.,STOCKTON,CA 952010388 <br /> (209) 4883420 <br /> r. NON,BEFUNOASLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED APP 1 08`1 <br /> ICLDpYM b LipTRLdI / <br /> -`PLICATION IS HEREBY MADE TO THE SAN MAW W COUNTY MR A MINT TO CONSTRUCT ANOAR INSTALL THE WOW(OESCNOM.THIS APFUCATION IS MADE IN COMRIANLF WITH LAN <br /> 'AWN COUNTY DEVELOPMENT TTTLE CHATfll&1110.3 AND THE STANDARDS OF BAN MAOUIN COUNTY PUBLIC HEALTH SEANCES,ENNIGNMENT L NFKTN OIN .. ^�I <br /> rWe AmRssroR AMI $101 W. afcc- -Tomfb 1ZD_ GISZIS- CT 'S-r L,K�TOM LOTIS� ,�l((�4C <br /> OWNEP's NAMEBRCEwL'TY�E'TTO ADDRESS l�IATAE PANE <br /> INTRACTOR ME-i)LL V 4 6*01;i, 14C,ACORM. SL50 6. FP10R9612➢, uLF-7,5q!5 I a PIDFIE 3L9-2552 <br /> KIS CONTRACTOR - Ip ADDRESS UCI RHINE <br /> TYRE OF SEPTIC WORN: NEW INLTALLATMIN p XFFAWAOMTOM ❑ DFLIMICTIOX❑ <br /> O SEF M SYSTEM PRMRTED E PUMUC SEWER IS AVAILASIE WITHIN 200 FEET OF SUMING.1 MIC Tfi I I HOW MANY <br /> AryEUBon I <br /> 11RTAl1ATOM WILL BER VE: RENOUNCE® COMMERCIAL O OTHER C3 1.y <br /> NLMLEI OF IMNO UNITS: I N1MLE11 OF wCONSIINKS: 14 NONER SOF EMROYEO: L <br /> ^YAMCTER OF SOX TO A DEPTH OF 3 FEET: CLR IPT!/BFLyMP SDN CMgBACTq: -oruoy WATERTALIE OEFTN �f <br /> l+TIC TANNMFALE TRAP ®TYPF/MFO COMa.f riL CAFACT11600 NO.COMFARTKNTS (i <br /> �O TREATMIXf PLANT 13 DISTANCE TO NEAREST: WELLFWNOATNN FOPMY UK <br /> LIST STATION 0 SIZE TYPE OF KIM, SAND OF.LPA TDR IFHCIpsm SYSTEMS <br /> J Fuwo UNE 0 NO.L IENUR OF UNES J—IGO ZF`1 FZ�TIBTiANC9/E TO NFAPFSf:WFIl LOQI�FOUNOATON�PIOPWITYUNE <br /> .TEILEO IJ MOTH IEHGTH DeFTI DST.WCE TO NtAREm NIIL MUNDATOM ROPEIT'UNE <br /> 3UNDED 13 we ILENGTH DPWI IIAUFE DeTNSE TO NEAREST:WELL FOUNDATION POPERTY UNE <br /> @ <br /> SAOE RTL ®OF➢fXAAS�CCII� WEILISOF4 FOUNDAlON 65 FROFFNTY UNE <br /> SV.1p (3WgEI Lomi DEPTH DISTANCE TO NEAREST:WELL_FOUNDATION NOPMY UNE- <br /> KNOW NNOL ❑CHAPS UNGTX NOFN DIGTANLE TO NEAREST:Wli FOUNWTbN FPOPMY UK <br /> �,JERELY CERTIFY THAT I HAVE PREPARED THIS APR CATION AND THAT THE WOR(WU.WE DONE IN ACCORDANCE WITH BAN MAWD COUNTY ORDINANCES AND STATE LAW I.AND RULES <br /> AND REGULATIONS OFTHE SAN MAW W CWNTY.HOW OYMENORLCENSED AGENT'S SIGNATURE CERT RU THE FOLLOWING:-ICU TIFYTHATMTK PNORMAXCEOFTNEM9WLFORNMILX <br /> TMS PW WR M IMM,I S NOT EMPLOY F PAWN IN SUCH A MMMN AS TO BECOME WWECTTO WORKMAN'S COMPNGTWN UWS OF CALIFOM.&- CONTMCTOR'S HIWNG ON <br /> SUBCONTRACTING MGNATURE CENTHES THE FOLLOWINS:'I CERTIFY THAT IN THE FEWONAANCE OF THE WORK FDR WHICH THIS PURER IS ISWED,I SHALL EMPLOY FEN90H8 SVRUECT TO <br /> OMMAN'S COOWKNBATION`LAWS OF CAUFOPNA.' THE APPLICANT MUST CALL N RONIN IN ADVANCE FON AUL REQUIRED INSPECTIONS. COMPLETE DMWING BELOW. <br /> `11:NED X TV '�/ �lM-Tl� TDLE: (L1y/'iL.t'O F-F LZSF DATE, 09I 10101 <br /> ROT RAN ORUW TO¢ALF)SCALE'IDL_ <br /> NAMES OF STREETS OR Ri NEAREST TO OR BOUNCING THE PMFFRTY. A.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM ON PROPOSED <br /> OUTLMY OF THE PROPERTY,WITH DWENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DBPoGAL SYSTEMS. <br /> DMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION OF WELLS WRXIN RADIUS OF ONE HUNDRED FIFTY IT.ON - <br /> >•INCLUDING COVOED AREAS SUCH AS PATIOS.ORVEWAYS.AHO WALKS. THE MORRTY ON ADJOINING PROPERTY. <br /> PAZ:✓EwF}y,. <br /> II p'�'' <br /> . � <br /> ilk SI <br /> 1>15w cc <br /> n <br /> 1 <br /> t <br /> 7. <br /> Ub1 35 i �F{e;F, <br /> y�NCy gM��� <br /> E�+ .w <br /> FOR DPAATMENT USE ONLY /y �J <br /> AiRUCM10N ACCPREn BY DATE: �/ O ANFA �i <br /> TAR(,Rf OR 6VMPINBRCT�I\TO'.N-ABY}' ,/E+. y1 DATE / / HNAL INSPELTON BY DATE iI <br /> ]DTMNM LOUIUEA :�\ �{1 l 1 I 1 I�Q E� 1 N <br /> LCtOVNDNO ONLY: NOI FACT <br /> FECODE FEE ILEO MIOVNT NFMITiFD CIB AMI RECENm BY OAT[ N/PEIKET <br /> NVBW6I INVOICE) <br /> lz� ) 3 +anis F lo% <br />