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APPLICATION FOR Liam WASTE PERMIT Past S"JOAQUIN COUNTY PUBLIC HEALTH St-;,-)VICES 2 �b4w^ ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 gellal4 (wI Arl+ sect) (209)468-3420 414 � tNOR-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED �� L,�„�, (Complete M Triplicate) APPLICATION 18 HEREBY MADE TO THE 8A k AQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. T1418 APPLICATION IS MADE IN COMPLIANCE WITH BAN JOAQUIN COUNTY DEVELOPM TITLE,CHAPTER 8-11/10,3 A�N+D.GTH STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. JOS ADOREBBlOA APNR CITY��/�r�""`� LOT SIZE At' I OWNER'S NAME E'er 12 . ADDRESS,+l ' PHONE CONTRACTOR �� ADDPE'SS/21 +� �`rG��!• 6J - �}f� LICI 7 (PHONE (?3- 5` .3 SUBCONTRACTOR ADDRESS Lice PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRIADDITION "A""CTOM❑ IND SEPTIC BYSTELR PERMITTED IF PU@UC SEWER 18 AVAILABLE WITHIN 2001111 OF.. NO.) PERC TESTIvI 1 I HOW MANY ApglplSon INSTALLATION WILL SERVE: 7WENCE COMMERCIAL ❑ OTHER❑ NUMBER OF LIVING UMTS: NUMBER OF BEDROOMS: NLWBBI OF EIPLOYF�S: 1 r ' CHARACTER or-BOX BOTO A DEPTH OF 3 FEET PITISUMP SOIL CHARACTEg-.//gI4 Ci001 WATER TABLE DEPTH SEPTIC TAHKMF.ASE TRAP ❑TYPENFO CAPACrTY NO.COMPARTMENTS PKO TREATMENT MANT❑ D1StANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE UFT STATION❑ SIZE TYPE OF PUMP�/ SAND OIL SEPARATOR IENCLoBED SYSTEM) ,r� LEAGHINO UNE NO,s LENGTH OF LINES 7Q /e 40W 019TANCE TO NEAREST:WELLI 0 "+� FOUNOATION 35 PROPERTY LINE 406 f to" FILTER BED /❑WIDTH LENGTH DEPTH 016TANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH DEPTH D19TANCE TO NEAREST:WELL FOUNDATION-PROPERTY UNE aFJ:PAOE PITA )0007��SIZE.. NUMSEA J1 DISTANCE TO NEAREST;WE G�� FOUNDATION 'v PROPERTY LINE�� •�^ SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE 4 DISPOSAL PONDS Q WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT 1 NA EPARED THIS APPLICATI AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWe,AND RULES AND REGULATIONSOFTHEIIANJO iNCOUNTY,HOME0 ER ORLICENSEDAOENT•9&ONATURECERTIFIESTHEFOLLOWINO:'ICERfIFYTHATINTHEPERFORMANCEOFTHEWORKFORWWFIICH THIS RMIT 18 ISSUED,I SHALL NO PLOY ANY PERSO SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFOIINIA.` CONTRACTOR'S HIRING OR SU •CO V CERT IE9 THE FOLL0 ERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO RK A 'S M T LAWS O ALI IA.' ANT MUST CALL 24 HOURS IN ADVANCE FOR ALL IIEOLLSIED NBPECTIONS. COMPLETE DRAWING BELOW. roll, SIO D X T1TlE: . - _ DATE: - PLOT PLAN IORAW TO SCALE)SCALE 'to 1. NAMES OF Sf S O ADS NEAREST TO OR ROUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. .. _ ... -- -..�, ., CL_ .. ... .... ... .. (b . : .. � .. . - ...... ... "° SEP . 1998 tX8, I: SA�,JCJAQTY _ENVIRONMENTAL ICE5 flIYLS ......, . — - �_ �- FOR DEPARTMENT USE ONLY G$ z [ 1 _.IWLX4TaiN ACCEPiFD SY DATE: AREA: 'fig * MIfSCTgN 8Y TE 1 ! FINAL INSPECTION BYhVIM DATE ! T9s '. . I•Mi PJYIaMeBM Ef± MDR FACR "0 RYOy1IT IILNBITED utter ASH ilECE1VED BY DATE SRI P80" T NUMBER _INVOICE/ 3q 1-7 L4 ��tq.?- /6 �