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APPLICATI IN FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WE13ER AVENUE,STOCKTON,CA 95202 (209)468-3420 NON-REFUNDABLE PiERMIT EXPIRES 1 YEAR FROM DATE ISSUED (CompMM1 In Trioliut.l APPLICATION IS HEREBY MADE TO THE BAN JOAGUIN COUNTY FOR A PEPNIIT TO('ONSTF(l1CT ANDR)R INSTALL THE WORK DESCRIBED.TNIB APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAOUIN COUNTY DEVELOPMENT TOLL CHAPTER 9-1110.33 AND THE J�_STANDAP)S OF SAW JOAOUIN COUNTY PUBLIC HEALTH/.SSERVICES,iEN"MNMENT LL HEALTH DI"6*N. JOB ADDRESSOR APNf lr}'S� �^aT- L' y(^ I}f'v�� ±S�C"::IA<rcm J�S�DL1(1 LOT SIZE OWNER'S NAME Z,; 1� 1)l'l L Ci ADDRESS_ CONTRACTOR "1'1 I Y-G c 41I tr ADDRESS_ P(-,) L'�� LKI lJd�i CiPHONE��7'7 77 3 A SUB CONTRACTOn ADDRESS UCf PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ZF REPAIRIM DITION ❑ DFATRl1CTON❑ IND SEPTIC SYSTEM PERMITTED IF R/BUC SEWER 16 AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTI.1 1 HOW MANY ,�(/ ApPSwtlon J INSTALLATION WILL SD(VE: RESIDENCE YK COMMERCIAL❑ OTHER C NUMBER OF LIVING UMTS:_NUMB@(OF BEDROOMS:NUM59/OF EMPLOYEES: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: S�✓`GL Y PHISUMP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANK/OREASE TRAP 2r-fpE/MFD P r L _CAPACITY t O '7 / NO.COMPARTMENTS 1 R(G TREATMENT RANT❑ DISTANCE TO NEAREST: WELL FOUNDATION S PROPERTY UNE 10 I 11FT STATION❑ ozE TYPE OF PUMP- SAND OIL SEPARATOR(ENCLOSED SYSTEM)-----T-LEACHING UNE !:7 NO.&LENGTH OF LINES �F -�71 _DISTANCE TO NEAREST:WELL 17>0 UNDATIONFO PROPERTY LINE FILTER SED ❑WIDTH LENGTH DEPTH__DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH DEPTH__DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE t®ROE FITS ❑DEPTH 81ZE NUMBER_ DISTANCE TO NEAREST:WELLFOUNDATION Pno PER1Y LINE_ SUMPS B�WIOTH_�LENGTH_DEPTH_-"1 r-DISTANCE TO NEAREST:WELL L b D FOUNDATION PROPERTY UNE DISPOSAL POND8 ❑WIDTH LENGTH DEPT"--DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE I HERESY CERTIFY THAT I HAVE PREPARED THIS APRiiCATION AND THAT THE WOR<WILL BE DONE IN ACCORDANCE WITH SAW JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES AND PEOULATIONS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGE 4T'8 SIGNATURE CERTIFIES THE FOULDTYING:'I CEFRIFYTHAT INTHE PEF MMCE OF THE WORK FOR WNICH THIS PERMIT IB ISSUED.1 SHALL NOT EMPLOY ANY PERSON N SUCH A MANNER A8 TO BECOME 8USJECT TO WOWMAN-8 COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB.CONTMCTING 81GNATlIRE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT N THE MRrORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO MW,,,N'8 COMPENSAT,�IONLAW��'$OF C fAUFOR NIIA.' THE AR"T MUST CAU.244t!t!IN ADVANCE FOR ALL REOt1REDGTINSPEC"ONS. COMPLETE DRAWING BELOW. .. SIGNED x Q" YV TITLE: ��✓1 1 G L.'I-�r DATE: fq�'Inj o1 ROT PLAN(DRAW TO SCA'u1 SCALE -to 1.NAMESOF STREETS OR ROADS NEAREST TO DR BOUNDING THE PROPERTY. S.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RAMS OF ONE HUNDRED FIFFY FT.ON INCLUDING COVERED AREAS SUCH As PATIOS.DRIVEWAYS,AND WALI(S. THE PROPERTY OR ADJOINING PROPERTY. .. ..... .:...... �(1T: i ....:....r.....i .:......c....i.. L... ....., k, ....<......:......v.... ...... cb . .. .. 2q G IN ID (� _;...s........ ..... L _E ;..... 4.....: ..................... .w..... ...._s........... . €...... © aL ........... .. �.. 1 1 AY w C4U(vT:Y... .-. . - P�k�dC.HEt.[T73 yE:iN{�'cS �- -� � � `�IJIIIfiCfM1d[NT?L,i�;LTH aVISInn: 1_ J y ,F(IR DEPARTMENT USE ONLY APPLICATION ACCEPTED By 14 ,. �I 1 Vim"-'`� DATE: ALAE S !; a TANK.PIT OR SUMP INSPECTION BY .)ATE / I FINAL INSPECTION By DATE J/ -' ADDRIONAI COMMENT S: V ACCO VNRNO ONLY: AID# FACT PE CODE FEE INFO AMOUNT REMHTE_D CNEC" ASH RECEIVED SY DATE SR/PETO,IIT MEMBER INVOICE f -75141cT 9 / Pub.Health Serv.-Enviro.174(3/96)