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APPLICATION FOR LIQUID WASTE PERMIT' <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> BOX 888, 304 EAST WEBER AVENUE, STOCKTON, CA 95201388 <br /> (2091469-3420 <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ato In <br /> atel <br /> ARVCATION IB HEREBY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/ORIIINSTALL THE WORK DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH BAN <br /> "AMIN COUNTY DEVELOPMENT TITLE.CHAPTER 8-111 L0.33 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADORE66/OR ASN! / 5 O (�) 1�.j I� L/c),c <br /> -f- we-'s <br /> (^ �J _ Cm '""^ / (� LOT SIZE �Y�I <br /> OWNER'S NAME / O/S P[ E'r( {"k" ADDRESS_ / S(!r/ LN T�i l� I� p�0 LY / PHONE 75; <br /> CONTRACTOR_ C l7A�'1 RC tt r r �r /AKADDRE86 7O JE30X / 3 �' LIES 7 9 34/ '27 y 2 12_ <br /> PONE <br /> SUB CONTRACTOR ADDH£BS ?'�QrN T�PAJ CI¢ �$� �6 UC0 R10NE VIro -di' (qC <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPAINADO TION ❑ <br /> DESTRUCTION ❑ <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.( PERC TESTIH I I NOW MANY <br /> APPBPBBen IF <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER t� <br /> NUMBER OF LIVING UNITS: NUMBER OF 111DROO/MM <br /> S: NUB[F1 OF <br /> CHARACTER OF 601E TO A DEPTH Of J FEET. OAt j /eo -1 M/SUMP SOIL C�HAARRA�CTT.W WATER TABLE DEPTH <br /> SEPTIC TANKJGREASE TRAP P.TYPE/MFO T� /</-SAdJ(C+R-y /6O c NO.COMPARTMEMB L <br /> WO TREATMENT PLANT ❑ DISTANCE TO NEAREST: WELL /2.O Y FOUNDATION IO i PROPERTY UNE O&t <br /> UFT STATION❑ 6IZE TYPE OF PUMP ^^ BAND OIL SEPARATOR(ENCLOSED SYSTEMI <br /> UNOp <br /> LEACHING E 11B NO. LENGTH Of LINER � (2-3) / - Z �'! DISTANCE TO NEAREST:WELL FOUNDATION YD Z iNWPERTY LINEi��H� <br /> FILTER RED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOVNDATIOH PBOPERTY LINE <br /> MOUNDED ❑WIDTH__LENOTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> SEEPAGE RTS ❑DEPTH BRE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PPAPERTY UNE <br /> BUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL PONOS ❑WIDTH_ LENGTH__DEPTH DISTANCE TO NEAREST:WELL FOUNDATION P10PRTY UNE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS AP ICATION AND THAT THE WOR(WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REOULATMNB OF THE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CEBTNIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br /> THIS PERMIT 19 ISSUED,1 SHALL NOT EMPLOY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUFORNIA.- CONTRACTOR'S HIVING OR <br /> 6UB{ONTRACTING SIGNATURE CERTIFIE THE FOLL NG: "I CERTIFY THAT IN THE PFRPORMANCE OF THE WOW FOR WHICH THIS PERMIT IB ISSUED,I SHALL EMROY PERSONS SUBJECT TO <br /> WOR(MAN�KN OF UFORNIA." HEAPPII NTM 'C"ALL 2A HOURS IN ADVANCE EOR ALL REQUIRED INSPECTIONS. COMPETE DRAWING BELOWSIGNED X( � TITLE OATS -/G / 3� <br /> ROT PLAN(DRAW TO SCALE(SCALE_ "to <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. A. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR P OPOAFn <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE D48MBAL SYSTEMS. <br /> J. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTUREB. B. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS.AND WALKS. THE PROPERTY OR AD.IOINING PROPERTY. <br /> VOL <br /> 7l <br /> ( '�iULV KIT,q <br /> 1 <br /> f y, J <br /> �Q�QIir►Al i ��Ee <br /> 135 <br /> Weld <br /> N�k� 2319 <br />