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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA %%1.388 <br /> (209) 468.3420 <br /> MON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> in <br /> APPLICATION AQUCO IB HEREBY MADE TO THE SAN JOA¢UIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIO Ikj'NSTALL THE WOO(DESCRIBED. THIS APPLICATION IB MADE IN COMPLIANCE WITH BAN <br /> stel <br /> JOAOUIN COUNTY DIVE COUNTY <br /> CHAPTER 9. <br /> 9.1110.3 ANDTHESTANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDRESSOR ApI ( -7oo ( u {7 ?A�h/ R-DI <br /> OWNER'S NAME {L)h� t�cJ' [*C' Cm-LL/fK�`A LOT ERE,2I aA. <br /> ADOgE89S l C7 ishF2.So:L. Cet'f: iAi,IP�� 9S Q3 7Llea <br /> CONTRACTOR./!/f[A'7FLM �yY PHONE_ 944. 7 9(p/ <br /> ADOREBsL/ �. u.� •� (/ GJ,( SZA* T �L <br /> 6U8 CONTRACTOR MISy y 5 PNGNE_Ul 5 3 L/3 <br /> ADDRI BB <br /> LX I RHINE <br /> TYPE OF OIRTIC WORK: NEW INSTALLATION ❑ <br /> 1:E11 11IIR/11Od1 RI STIRIICTIOM ❑ <br /> INC SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF IsUILDING.f <br /> PE1C TESTHI I 1 NOW MANY <br /> INSTALLATION WILL SERVE; RESIDENCE COMMEgC1Al ❑ OTHER ❑ ApylwUon I <br /> —� <br /> NIAAtE1 OF LIVING UMTS: NWSER OR BEDROOMS: <br /> CH -T1R OF BOIL TO A DEPTH OF 3 FEET: rt�/�/w NUMBER OF EMPLOYEES: <br /> PT/BUMP BOIL CHARAC q, WATER TABLE DEPrm <br /> �tFPTIC TANK/ORFA*E TRN ❑TYq x. /I 1� n _ C �J <br /> PCO TREATMENT RANT O DISTANCE TO t ~_C•LakC. �'rCl A Cm, 21XrJ G_ ,Q f NO.COMPARTMENTS J <br /> NEAREST: WELL. // O <br /> UFT STATION❑ SIZE � FOUNDATION � ppOpEgry UNE ,'CZ t11- <br /> LEACHING <br /> � O <br /> i44}}}ryyyrr TYPE OF PIMP`, BAND OIL SEPARATOR(ENCLOSED BYSTEMI-- <br /> LEACHNO UNF O" :; B LENGTH OF LINES —-T N �.`h a �T <br /> FILTER BED /❑WIOTN DISTANCE TO NEAREST;WELL4;lc r f- yUNDATgN pgOpFgFT.UNE E EQ -(- `. 1 <br /> LENGTH OEpiH DISTANCE TO NEAREST:WELL <br /> MOUNDED ❑WIDTH FOUNDATION <br /> LENGTH DEPTH DISTANCE TO NEAREST:WELL PROPLRTY UNE <br /> SEEPAGE RTE DEPTH <br /> 2•-- 4 '• NUMBER / FOUNDATION P,DpI UNE <br /> DISAM DISTANCE TO NEAREST:WELL `iOC'n" FOUNDATION t' / <br /> ❑WIDTH LENGTH DEPTH �PROPERTY UNE <br /> DItbtµbMB* DISTANCE TO NEAREST:WELLFOUNDATION <br /> ❑NSOTM LENGTH DEPTH PROPERTY UNE <br /> HE _ DISTANCE TO NEAREST:WELL FOUNDATION <br /> PROPERTY UNE <br /> Wily CERTIFY THAT I H T THE <br /> DRGRAA NJOApU NI COUNTY.HOME OWNER ENSEO AWOM'B BIG"�MCERTITiEB THE FOLLOWING;'IVI ICEITIFYTNAAQUIN T NTNE�PEgFpgMAN*DEATHS WOq(FOq y��N <br /> THIS T IS I ED.I SHALL NOT PL PERSON IN SUCH ANNER A8 TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTNEWDIVB ORWH OR <br /> BUB OMRACTINO U C (FIE HE LLOWINO: 'I CERT AT I I THE PERFORMANCE OF THE WORK FOR WH THIS PEgMT IS ISSUED,I SMALL EMPLOY fFg80N8 SUHIRINGBJECT TO <br /> WMAN'8 COM TON ISO IA• HE/ BT CALL 24 HOU S IN ADVANCE FOR ALL RtGLARED INSPECTION*. COMPLETE ALL EMP BELOW. <br /> $ZONED X <br /> /I <br /> TILE: 1, ELT'�E:Ct,' DATE: <br /> PLOT PLAN(DRAW TO SCALE)SCALE <br /> 1, NAMES OF STREETS OR PO -NEAREST TO OR BOUNDING THE PROPERTY. Ru <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. t. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> c — THE PROPERTY OR ADJOINING PROPERtt. <br /> ' �•— � i �-F/LT% _ TLC:{ .�.. '. <br /> f -T <br /> i <br /> 1� <br /> Mo��+w <br />