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APPLICATION FOR LIQUID WASTE PERMIT °� • o ' ---M JOAQUIN COUNTY PUBLIC HEALTH SERVICES i ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 448 N. SAN JOAQUIN ST., STOCKTON, CA 982010388 12091 4883420 NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Compl4tB In Triplintd) APPLICATION IB HEREBY MADE TO THE SAN"AMIN COUNTY FOR A PERMIT TO CONSTRUCT ANOIOR INSTALL THE WORK DESORBED. THIS APPLICATION I6 MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TREE.CHAPTER 9-11110.3 AND THE STANDARDS OF SAN JOADUIJ COUNTY PIBLIC HEALTHCERVII�C.ES,ENVIRONMENTAL HEALTH DIVISION. JOB ADOWSSIOR((��APP�NI 35 I y W.�tP P`t-•` G Y! C p -f.Cm lµ �� pL�OT SIZE 1RLA 4^CLEVbcAAG 1VVC LAADDPESS 1�1C 1< E / IVC LV PHONE 03S'•�1vZC� OWNER'S NAME / 1_ L/Doc7 /N �tJF SOLA LZ LICE ICX�SI L PHONE X07 CONTRACTOR C.IV V�.7 L" / \ ADDRESS SUBCONTRACTOR ADDRESS mo PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION REPNRIADDITION ❑ D"TRucnON ❑ INO SEMIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.1 FERO TEBTIO I I HOW MANY APPEPBdPR r INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL K OTHER❑ NUMBER OF LIVING UNITS'._ NUMBER OF BEDROO[�MI: NUMBER OF EMPLOYETJI: CHARACTER OF Wit TO A DEPTH OF 3 FEET: J41A A WT/BUMP BOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANSIOPEASE TRAP I&TYPEIMFG C.V G CAPACITY��.COMPARTMENTS I LJ V MG TREATMENT PLANT❑ DISTANCE TO NEARUT: WELL ( t FOUNDATIC 1O 1 PROPERTY LINE LIFT STATION❑ SRF TYPE OF P1(J/ESP SAND (OIL 1SEPARATOR(ENCLOSED SYSTEMI �,E�(�� F L LEACHING LINE NO.6 LENGTH OF LINES LLAJ xVI�L IV`4l DISTANCE TO NEAREST:WELLS FOUNDATNINPERTY LINE LJ FILTER BED ❑WIDTH LENGTH DFE TH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE VI SEEPAGE RTS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPEREY LINE _ SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE Y DISPOSAL PONDS ❑WIDTH LENGTH7-DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPEREY UNE _ j I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICA]ION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH BAN"AMIN COUNTV ORDINANCES AND STATE LAWS,AND RULES / AND REGULATIONS OF THE SANMAWM COUNTY.HOME DINNER ORUCENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT INTHE PERFORMANCE OFTHE WORK FORWHICH G� 11116 PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTUP'S HIRING OR _ SUB.CONFN 111,10 A URE CERTIFIES THE FOLLOVYING:-1 CERTIFY THAT IN THE KROORMANCE OF THE WORK FOO WHICH THIS PERMIT IB ISSUED,1 SHALL EMKOY PERSONS SUBJECT TO WOWMAN'S COM NEAT N UWe OF CALISOPNIA,! APPLICANT MUST CALL 34 HOURS HE ADVANCE FOR ALL RRE'OI IRED IINSSPPWTIONPE S. COMFTE DRAWING BELOW. 1 -"'C.�_ • �C TREE: DATE: ✓ �"� \<L SIGNED X ROT RAN IDRAW TO SCALEI SCALE -U° _ 1. NAMES OF STREETS On ROADS NEAREST TO 0Y1 ROUNDING THE PiLOPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OP PROPOSED 3. OUTLINE OF THE PROPERTY,WEEN DIMENSIONp AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. F 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY IT.ON (� INCLUDING COVERED AREAS SUCH AS PATIDB:DMVEWAYS,AND WALKS. THE PROPERTY On ADJOINING PROPERTY. I L , I I ! �Iza y lw.u,� A c � 1 _'- D.APARN511 � - - - 1 hlAk 2 8199/ _ I � I - :I•TDacIMA�� IISBII I I I !. I � I MR ppMTMFNT WE ONLY -JVI C lME�T Pett r;I-nl,l li glEl. u.�1/„ APPLICATION ACCEPTED BY /1` - � DATE: I Ate: w G TANK.PIT OR SUMP INSRCTIO'N,,(1 �p� ��♦ ...,.a /I� DATE l I FIIINFIAL INDSPPE�CTION BY f yl.., DATE l I I /L7 ADDITIONAL COMMENTS: ACV ",Jt 1 � aquk - CtKd K ,J t Ake a"oA .v i1^2 w Jnr, `,fie J-PLe�lua-LlI K2 y ACCOUNTING ONLY: A1U/ FPCI PE CODE iFF INFO AMOUNT ROMTTED CHECK/BARN RFCDVED BY ORf N/PD ry NUMBER INVM([f I y I So O. o0 7K'7 3 a�1