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APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O.BOX 308,446 N.SAN JOAQUIN ST,STOCKTON,CA 56201-0388 1205)4803420 • NOM REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (ConPMb Is Triplicate) Application Is hereby Towle to the Sen Joaquin County for a posit to construct and/or install the work described. This application Is made in corpliance with San Joaquin Canty Development Title, Chapter 9-1110.3 and the Standards of San Joaquin County Public Health Services, Enviroreental Health Division. Jab Ad}resa/or API# ae 3 S3 �nI l-)7i.�Fw �?9 city Lot sire Owner, MamaT � Y'OTJ Address --� \\ Phone_y4�'o�'�7a. contractor �'�-- � � -. Adtlnas • "V S 1 --•ySlo,n e "J- LICS .S�la 11 - Ph" 3I;y,zi33 Sb ContractorV Address Lic# Phone TYPE OF SEPTIC MAIL NEW INSTALLATION I 1 BEPAIRIAOOITION W- DESTRUCTION I I PERC TESTW I I Nae nssy— (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 2DO FEET OF BUILDING.) IoM U.ApReadasI Installation will serve: Residence_ Cmreercial '/ Other_ Number of Living units:_ WLW r of badroomal_ Number of atpioyaaa:__ Chanctar of soil to a depth of 3 feat: Cjay pitleuip Solt Character:rn4Y CMj Nater Table Depth )Ob r S®T BNEASE TRAP 11 Typo/M} r,.,enLaj--I ' /hTf'G CopaattY /" No. Ooepartsents�_ PKD TREATMENT PLANT I I Distance to nearest: Well FaudationProperty line o LIFT STATION❑ Site_Type of Pu¢__Sand Oil Separator (enclosed systems) N LEACHING USE W. No. S length of tires /'I DistantO"rtNearest: WeLt_&52L Faadetion Property Lim ?A/ lZ FILTER BEL [I Width_Length_Depth: naf l` iCSz/I WeLL_ Foundation.Property Line� MOUNDED ❑ Width_Length_Depth_ "`"/ Well_ Foundation_Property Line_W _L �_ Well�� Foundation "' Property Line� Z SEEPAGE MTS Jr' Depth-2.5:7 Sf se Naber ° " �a.,i-2-o x SUMPS [] Wf duh__LugW_D¢Pth_ " " W¢ll_ oudat ton_Property Lim DISPOSAL PONDS [1 Width_Length_Depth_ " " WeLL__ FnssAtion_Property Lim P x I h.raby certify that 1 have Praperad this application ab that the work will be done in accordance with Sen Joaquin Canty Ordimnats and State Laws, and Rules and Regulations of the San Joaquin Canty. None owner or lfcemed agent's signature certifies the follwlrg4. "1 certify that in the perfa mme of the work for Which this permit is issued, 1 shell not employ any person in such a carter ash to becam subject to woriumy n's coensation Laws of California.• Contractor's hiring or sib-contracting Signature certifies the following: "I certify that in the performance of the Mork for which this Pemit is issued, I shalt employ Persons sbjatt to workean'a-1, compensation Laws of California.• The a1p5mot Put rat 24 A un in ad .far eg ,*ad kepands . C.Wt.te drsuing bel.. SiGaea X /T// /(f71 Title: N�nr2 _Date: 41- 7-3S- PLOT -SSPLOT PLAN (Draw to Scale) Seale_" to 1. Nacos of streets or road$ merest to or hooding the property. 4. Location of house Sewage disposal systm or 2. Outline ofthe property, with dinensiom and North direction. proposal sepamion of sewage disposal system. 3. DiaMmfoed outlines and Location of all sxlating mrd Proposed S. Location of walla within radius of 150 ft. on structures, including covered areas such as patina, driveways, t e property or adjoining property. ' and walks. ( QLf S/�/enrL e i J Q �(� PAYMEN sFrEl mfE u ou ry I ONM NIA HE LTH 6- n / ^^_�- FOR DEPARTMENT USE ONLY �J�`•lJ /lam/(//f Application Accepted by Det.: 7 4SArea:-1-21L/ Tank, Pit or Sump Inspection by Date / / Finat inspection by Data Additional Cosments: Now 3o-0 ! /✓ -C woo Sr�S ACCOUNTING Duty. AID# FACS / PE CODE FEE INFO A UNT UtUTTEO E N RECEIVED BY DATE SR I PERMIT NUMBER INVOICE S / 3 'C� 6 n� n ��] `pZOD B