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LAPPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Ia, �u <br /> a.twA .'ma.l I ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (r-A .h.d -"1) (209) 468 420 <br /> k,A� .r, Kr Gr... <br /> M011•REFUMOABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> �h-I 4 - Ic*Inpat. in Triplicate) <br /> IMI 1 <br /> APPLICATION 18 HEREBY MADE TO THE SAN AOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WO HE LTH SERVICES. <br /> S.E APPLICATION L. MADE IN COMPLIANCE WITH 8A <br /> JOAOVM COUNTY DEVE<OPMf�T TITLE.CHApTvn 9-1 110.3 A�N-O T,11J-�/SITANDARDS OF LAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES.EHVIRONMEMAL HEALTH Df VISION. <br /> J(V�J/,El��l�t-•/cif/1/ CTI r�/X16 LOT SIZE <br /> JOB ADDRR-68/OR APN/ QQ <br /> CL�g <br /> T12 . ADORES9 PHONE <br /> OWNER'S NAME /A/ �� <br /> 443 <br /> CONTRACTOR `y C (YI ADORES.! 7 LL�C-/7• ✓ • C.. LKS <br /> _ SUB CONTRACTOR <br /> AGGRESS UC/ PHONE <br /> DEXTRUCTIOM <br /> TYPE OF SEPTIC WORK: <br /> NEW MLL <br /> tTAATpN ❑ REPMR/ADOPTION ❑ <br /> /ERC TESTI.)l I HOW MANY <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BU .1 <br /> A9PSo�ten I <br /> INSTALLATION WILL SERVE RESIDENCE�COMMERCIAL ❑ OTHER ❑ <br /> NUMBER OF LIVING MBTS: / NUMBER OF SEDROOMS: NUMSER OF EMPLOYEES: ,,,�7 <br /> CHARACTER OF 600.TO A DEPTH OF FEET PITfSUMP SOIL CHARACTIE : A WATER TABLE DEPTH ( <-'�T� <br /> SEPTIC TANKA7{EASE TRA( <br /> TYP£lMFD CAPACITY NO.COMPARTMENTS <br /> IKO T'RFAITMENT PLANT❑ DISTANCE TO NEAREST: WELL <br /> FOUNDATION PROPERTY UNE <br /> UFT STATION Cl SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> DISTANCE TO NF /ODI <br /> Q' �n r <br /> - LEACHIPM UNE NO.t LENGTH OF UNE S. 7 �i RC2 MEST:WELL/ FOUNDATION L-C� '� FTOPERTY UNE <br /> FILTER BED ❑WIDTH LENOTTi <br /> DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> r-�s—i L FOUNDATION � PROPERTY UNE <br /> SEEPAGE FITS F�__-BQE�Mn'ABER,/�,__DISTANCE TO NEAREST!WELL <br /> sLIMn E]wroTH <br /> LENGTH DM-DDISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE— <br /> [3 <br /> NE <br /> [3WIDTH EN <br /> LOTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> DISPOSAL POND* <br /> 1 HEREBY CERTIFY THAT I NA PARED TI-09 Al'PLJC AT AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE SAN JO COUNTY.HOME ORUCENSED AGENT'*SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT W THE PETWOPMANCE OF THE WORK FOR WHICH <br /> THIS f ULA 1!ISSUED,I!HALL NO PLOY ANY DOME SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALJFOFIAA.' CONTRACTOR'S HIRING OR <br /> -CO N CERT IES THE NY ERTIFY THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS tSSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> RKM 'S T LAWS O A.' ANT MUST CALL 24 HOURS IN ADVANCE FOR AtLL/^701U`R�,INSPEN:TTON*. COMPLETE DRAWING BELOW. `�J] <br /> I TITLE: <br /> _DATE: <br /> STONED X <br /> ROT PLAN DRAW TO SCALE)SCALE__ 'to <br /> 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 1. NAMES OF so ROADS NEAREST TO OR SOUNDING THE R70PERTY. E%PAIBION OF SEWAGE DISPOSAL SYSTEMS. <br /> 2. OUTLINE OF THE WITH DIMENSIONS AND NORTH DWECTIOH. <br /> S. LOCATION OF WELL!WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br /> ON <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURE.. THE PROPERTY OR ADJOINING PROPERTY. <br /> INCLUDnJO COVERED AREAS SUCH A8 PATIOS,DRIVEWAYS,AND WAXB- <br /> SSSS SSSS .. .1.......-. ........ .l ..'...... ..._. <br /> - . ... .. _ <br /> SSSS. SSSS. SSSS <br /> �� - .• ... .- .._.. .. SSSS. ... <br /> r, : e (t... <br /> .. <br /> 4r ...... <br /> 1 <br /> _ .. .. . <br /> w <br /> . <br /> _ __ ` 1:. <br /> ..... _ r <br /> ige ....... <br /> :.. .. . .. .. <br /> 14. ... .. _ 0■'rtj .. <br /> _SSSS ............ .. ... <br /> .. .. .. SSSS .. <br /> ....... _..t... SSSS_ 1.. _ � SSSS.. SSSS .. <br /> I SSSS SSSS.. <br /> SEP 1...1998._ <br /> _. .... <br /> . <br /> IAPIUlh LIMY <br /> PUBL;CryHEAIT D V� <br /> t EMVIRCMENT.IH <br /> _ . , <br />