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APPLICATION FOR LIQUID WASTE PERMIT <br /> -TAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES— <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P,O, BOX 3M 304 EAST WEBER AVENUE, STOCKT)N, CA 9520 <br /> (209) 469-3420 I 190,P <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FRUM DATE ISSUED <br /> n Tflplkmtml <br /> APPLICATION IS HEREBY MAOE TO THE SAN JOAQUIN COUNTY FOR A T'TRMIT TO O(NISTRVls I <br /> CT ANOIOn INSTALL YHE WOnK DESCRIDED. THIS AFTUCATION IS MADE iN CpMPLIANCE%-M BAN <br /> JOAOUIN COUNTY DEVELOPMENT TFFLE,CHAPTER 9-11 10.3 AND THE STAT ' B OF BAN JOACIi COUNTY PUBLIC HEALTH BERVIC Ee,ENVIRONMENTAL HEALTH OIVIBIO N. <br /> JOB ADDREBR/OR APNI <br /> uCfTY LOT BRE <br /> OWNrFi NAME C-'f f't PU rzp ADDRESS s <br /> PHON <br /> CONT RACTOR I--C L Ca• -C?.> 4� �-1 ADDRFSS <br /> ,S'7C:k. LICs'AAwl y_PHONEZ 9 <br /> SUBCONTRACTOR <br /> ADDRESS UC.P <br /> PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION JO AlrPARVADDITION ❑ DESTRUCTION ❑ <br /> fNO SEPTIC SYSTEM PERMfTTED IF PUBLIC SEWER IS AVAILABLE WITIHN 2M FEET OF BUILOING.1 <br /> PER C TEITIsF T 1 HOW MANY <br /> • S` ,v <br /> INSTALLATION WILL 6gRVE: RESIDENCEId COMMERCIAi ❑ pTHEq ❑ ApEliostlon! ,Le4 L.FC-j <br /> eEq 4F IJVING UNtT}: NUMBER OF}EDROOMI: NUMBER OF EMPLO YEW! <br /> CHARACTER OF SOIL TO A DEPTH OF 9 FEET: .�� TISUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> SEPTIC TAFtNiMFJI SE TRAP ❑TVPEfMFG CAPACfTY <br /> NO.COMPARTMENTS <br /> PHO TREATMENT PLANT ❑ DISTANCE YO NEARi WELL roUNOATION PROPERTY LINE <br /> LIFT STATION❑ SIZE TYPE OF PUMP RAND OIL SEPARATOR IENCLOBED SYRTEMI <br /> LTACHINO LINE ❑ NO.•LENGTH OF LINES UIRTANCE TO Ni WELL FOUNDATION <br /> 1•ROF'EFTTY LINE <br /> FILTER SE'D ❑WIDTH tirNGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION <br /> PROT4RTV LINE <br /> MOUNDED ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION <br /> P1TDL4ifTY UNE <br /> ■EFPAOE PITS ❑DEPTH BIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY t1i <br /> Rt mps ❑WIDTH LENGTH of DISTANCE TO NEAREST:WELL FOUNDATION PROIsERTY LINE <br /> DISPp SAi PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL EOUNDATPON PROPFITTY LINE r <br /> THEREBY CERTIFY THAT I HAVE PREPARED THIS AT'F1ICATION ANO THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'i SIGNATURE CER71FIES TH£FOLLOWINO:'I CERTIFYTHAT IN THE PERFOFV.RANCE OF THF WORT(FOR W!{ICII <br /> THIS PERMIT IS ISSUED,I&HALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WOFE(MAN'S COMPENSATION LAWS OF CALIFORNIA.- CONT MCTOR'S HIR1N0 OR <br /> BUS-CONTRAC7fNp SIGNATURE CERTIFIES THE FOLLOWING: •1 CERTIFY THAT IH TILE PERFORMANCE Of THE WOR(FOR WIIPCH THIS P'ERMPT IB ISSUED,1 iliALL EMPLOY PERSONS iUft GTO <br /> WOPr(MAN'B COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REGUTAED INSPECTIONS. COMPLETE bRAWINO BELOW. <br /> SIGNED X <br /> -S _ r <br /> TFTLE: 5;�AT / Lh- I� -ATE: <br /> PLOT PLAN IDRAW TO SCALER SCALE - <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORT"DIRECTION. <• LOCATION OF HOUSE SEWAGE 011 DISPOSAL SYSTEM OA PY1pP0&EO <br /> J. DIMENSIONED OUTLINES AND LOCATION OF Atl EXISTING AND P"OPOBFO STRUCTURES, EXPANSION OFIELILBDISPOSAL SYSTEMS. <br /> INCLUDING COVERED AREAS SUCH AB PATIOS,DRIVEWAYS,AND WALK B. 6. LdG ATIOH OF WELLS WIY IIIN RADIUS OF ONE HUNDRED FIFTY fT,DH <br /> THE PROPERFY OR ADJOINING PROPERTY. <br /> fa� <br /> CI <br /> \5a� Ra or ...�/ ... !� :lrsJO �ETIRS n - Re m---, Sr, [ o�.GL%�!v•� I��� *i�� <br /> ! Easurn HpQilss Q, R - � - - <br /> S o y _ /I Copperapolis d <br /> a —comperepolis Rd. ro <br /> in-_ 1/sj�� a� SAN JOADUIN -:••,,. i i. 11 v <br /> "n SL v. +` c ■ E AND <br /> _ ...PI TOL RAFIGE �I <br /> KI 1 <br /> RcT. �� 5 u, D ter - <br /> z� = F y 7 <br /> o �Dc 3 ��o <br /> J5 .. "�'��_\P.� San Julien G Ir'J w <br /> Rd.;- <br /> 8afn Owl Cr. SITE LOW x SAYRE <br /> 6 tgf. grcn p s <br /> T,nschoor, - tt 49.72 AC '3 z <br /> f.D, tr 900900 fe Se.1,,.,{� <br /> �To COILEO ILIE T tneq Cree�Aa: o cemk< 13 G tir. <br /> C ' a 1ka -0 o C 24 t02 E r p.1I a.t .� <br /> goo A - �DapO _° I f4�f 3Jr.9sitc.Ne r+ <br /> f� �0 L;nlrNhnf- GaR d <br /> wne+� .m x f9 ri4 Ga-ne g ry <br /> . <br /> r 6J'l.l h <br /> Vardan�.!y•y'� !o° xY..�. YYY ♦ - �'Off <br /> Farms Rd s� �0 �I,� , A <br /> - �� Q 7 a `' I; She;�". 1y O <br /> 10 <br /> Rd. <br /> Skiff "'d <br /> c, <br /> Wild food Rd '� 3 ,1e 9.oJ sc. <br /> 16 U} <br /> + Marle Baker Dodds }7 Rd. - Orr t ria 4C'' a a+d <br /> Epp A9 <br /> Dc I EJ <br /> 1 a S. 4C, ,1 sll <br /> Arena Rd. � ¢ � � � N!'r <br /> tfi��tcF �. <br /> Ke „ MUNRO � t +s I AVE. e + <br /> CORNERSa ,d <br /> C Lone Tree J9 o: � Rd. <br /> felon - .. <br /> Rd. 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