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r APPLICATION FOR 1.1010 WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SLHVIC1=5 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE, STOCKTON, CA 95202 <br /> C Yt.I (209) 468, <br /> Sh y. <br /> NOA•AEFUNOABIE PERMIT EXPIRES f YEAR FROM DATE ISSUED <br /> L4 f'r, 'w"'� - ICil1*I.T.In TTfRrRlt.I <br /> i•b _ CANUtOR INSTALL FOR <br /> }APPLICATION f9 HEREBY MADE TO E AP ER ON <br /> 0.3 AND A�STANOAI�9 OF CAN.tOA0U1N COUNTYPUBLICHEALTH BERV7CES.ENVIRONMENTAL HEALTH DIVISIONA E VATHjj <br /> JOAOVIN COUNTY DEVELOPM JJ LOT SRE!"� <br /> � rm I'/ <br /> 7L11G�- <br /> ,]OB AD{KtESB/DR APN■ �y ']` /� `,� <br /> (�G-aCi J •C. - ADOlE59 q rP1�OHE J � /3 <br /> +OWNER'S NAME G-L f PHON£ I7 _ 5 Y <br /> CONTRACTOR✓ +� " AOORESS Z� LICA <br /> LICa _PHONE- <br /> AppRE63 <br /> we CONTRACTOR <br /> REPAAVA80fT10N DEiTRUCTH)N <br /> TYPE Of SEPTIC WORK: NEW M9TAIJATION 0 PWC TVIT1+l I I NOW MANT <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 19 AVAILABLE W"IN 2DO FEET Of BU .I Appkedon f <br /> i <br /> INSTALLATION WILL SERVE-- <br /> RE�IDENCE COMMERCIAL❑ OTHER D <br /> numrER of aEVRooMI• NlJf4fe0l OF aApIOYF�E:��,�� � <br /> NUMlER OF LIVING UMTs:�„_,_ WATER TABLE DEPTH <br /> Pf rG UMP 9O1L CHARACTE <br /> CHARACTER Of SOIL TO A DEPTH Of FEET NO.COMPARTMENTS <br /> ���� CAPACITY <br /> sE1TIC TARKIGRE"E TRAP FOUNDATION _ _ PROPERLY UNE <br /> PKO TREATMENT PLANT❑ DISTANCE TO NEARMT: WELL <br /> SAND OIL SEPARATOR IENCLOSEO SYSTEM' <br /> UFT/IAT10N❑ 61ZE_ �TY�OF PUMP --I FOUNDATION PROPERTY LINE <br /> NO.k LENGTH OF LrtiE6 DISTANCE TO NEAREST:WELL/L�'CJPROPERLY LINE—' <br /> LEACHING UNE ST:WEU. FOUNDATION <br /> Fi Q WIDTH LEIiGTH DEPTH DISTANCE TO NEARS �.�- <br /> RLTDt SED FOUNDATION PROPERTY�E- <br /> ❑YMOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL —Z P/gpERTY <br /> MOUNDED r WE 'r' DISTANCE TO NEAREST:VYELL ��� FOIINOATIOH <br /> fes- iEEPAOE PITT � � FOUNDATION PROPERTY LINE--w.. <br /> DEPTH��DISTANCE TO NEAREST:WELL <br /> lump! Q STH ��— FOUNDATION PROPERTY UNE----, <br /> �H pEp{}t DISTANCE TO HEAt1ESTt WEEL <br /> DIspom POND. ❑WIOTN� —""�'�' STATE LAWS.AND RUtPS <br /> Alio THAT THE F6,1, M1111.BE DONE IN ACCORDANCE WR11&O .IOApUIIf 1'IDIAT RiTHE Nly ORDINANCES <br /> PETWQRMANCE OF THE WORK FOR WHICH <br /> I HEREBY CERT FY THAT 1 NA PARED THIS AP'PLJCA ORLK:ENSED A[iENT'!apNATURE CERTIFIESTRE FOLLOWINO:'I CEKTIFY CONTRACTOR'S HSVNG OR <br /> ANO REOUlAT10NB OF THE SAN JO COUNTY.HOME /Ua.IECT TO WORKMAN'!COMPENSATION LAW!OF C/iLIF'OfrlA.' <br /> PLOY ANY PER90 SUCH A MANNER All TO BECOME HIS PERMIT la 1lIR1EO.1 BIf1LLL EMPLOY pEIISON9 SUBJECT TO <br /> THIS fT t!1/9U8D,1/HALL NO ERTIFY THAT IN THE pEPiFORMANCE OF THE WOIML FOR WHICH N A6C N710 `. COMPLETE DRAWING BELOW <br /> O N CERT IES THEFOLLwm Fmr <br /> ou T LAWS O A.' ANT MUST CAIS 24 HOURS IN ADVANCE TOR ALL <br /> F! <br /> 7 DATE <br /> TITLE: <br /> ! <br /> SN3T�ED)C <br /> PLOT PLAN VMW TO SCAM SCALE���—�-�*10'� <br /> 1 j t. LOCATION OF HOUSE IEWAOEONIIPOGAL SSiEI�A OR PROPOSED <br /> 1. NAMES OF so ADS NEAREST TO OR BDUNDOW THE PFOFERTY. EXPANSION OF SEWA!!E OWO <br /> SAL- 2. OUTLINE OF THE WITH OIMENOONS EXE NORM DIPIECTION��S• S. LDCA7ION OF OR A CMN�l <br /> OF ONE HUNDRED FIFTY FT.ON <br /> 1. DoMEN91ONED OUTLINER AND LOCATION OF ALL EXISTING AND PRD THE-PROPERTY OR ADJOa11N0 pPgl'ERTY. r <br /> INCLUDING COVERED AREAS SUCH AS PATIOS DRIVEWAYS AND WAULB . <br /> ...-.. .. <br /> . ..... ........ .... :.... .....e'er..` s ..... ... . .. ,... ._Q �� . <br /> y .. <br /> `. 1:.. <br /> n <br /> s <br /> ., - .. 1 <br /> t Xm <br /> . <br /> ... .., <br /> FU8L3l HEAL TUN y <br /> VIRCNR4[ENTA H g'V <br />