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A giJU110 be LIQUID WASTE PERMIT <br /> pZGt$ N C NTT PUBLIC HEALTH SERVICES <br /> utTF couu� ,�, ENTAL HEALTH DIVISION <br /> S9�r 1011Q >o o a'.S. d. -T"Dt IN WEBER AVER,STOCKTOR CA 9621fts88 <br /> SpF,GIAL Ixosl aee.aato <br /> HOPI-MUNDABLE PERMIT EAPIKEB 1 YEAH FROM DATE ISSUED <br /> fCrnyMa iR TrfPYnM <br /> �(;pIrJCATION IS HEREBY MADE TO THE SAN JOAGIN COUNTY FOR A PERMIT TO CONSTRUCT—1,INSTALL THE WORX—,I—.THS AW'LICA—I8 MADE IN CLHMPUANCE MAT.BAN <br /> .IOROIAM COUNTY DEVELOP'MEENT TITLE,CHAPTER 9-11 10.3 AND THE STANDARDS OF BAN JOAOUN COUNTY EVBUC NEALTN SERVICES. <br /> "ENV muNMENTAL HEALTH DRRSION. <br /> R <br /> JOB ADORESSIOR APNf '�/ Jf/1 l J'y/•1JL� L7 CY [(yG�r LOT <br /> OWN6f / <br /> ER`S NAME �(_ iL�.(.K/ /"t�CQ/L,e��� AODRESB r+ PHONE <br /> CONTRACTOR _4,"(1Y�. 's•r/Jv'SL ADOgfSg T� �T'. UCE�RIONE��3 S 3 <br /> OUR CONTRACTOR ADDRESS L1CI PHONE <br /> TYPS OF SEPTIC WORK: NEW INSTALLATION❑ WAWADNTION O"Y"mTION❑ <br /> M SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 10 AVARAKE WITHIN 200 FEET OF A.DINO.) PlNC TieTIA I I NOW MANY <br /> ApPSwSn1 7 <br /> INBTALU.TION WALL#NNID <br /> E: RESIDENCE 00 COMMERCIAL 13 yr'OTHER❑ <br /> Nuomm OF LIVING UNITS: / NUMBER OF tBON0NUAMAR OF EMPLOYEES: <br /> CHARACTER OF SM TO A DEPTH OF 3 FEET: PRT/SUMP SOIL CHARACTER: ,./1.LI'�4aYVATFR TABIC DEPTH <br /> SEPTIC TAWKIG ASE TRAP ❑TYPEIMFO CAPACITY ND.COMPARTMENTS <br /> PRO T"XATIACWT FLAW❑ I STANCS TO NFAREfT: WELL FOUNDATION NgP61TY LINE <br /> UFT STATION❑ P ME On TYPE OF PUMP, SAOIL SEPARATOR(ENCLOSED SYSTEM) <br /> �.{1 ENLOW" 0 1 <br /> LEACHING UNE w/NO,i LH OF LINED iZ—6 O F1'L.S'f.-� DISTANCE TO NEAREST:WELL��FOUNDATION_PROPERTY U14C T_ <br /> FILTSII Sm (O VAUTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PIbPFRTY LINE <br /> MOUNDWD ❑WIDTH U9MTH DEPTH DISTANCE TO NEAIEBT:WELL FOUNDATION PRDPNRY LINE <br /> SEEPAGE FRS 0 vwrlN 82E NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PFIDPERTY UNE <br /> � <br /> SUM" v WIDTN �4' LENGTH1A'� DEPTHV�OI8TANCE TO NEAREST:WELL' HpLJNOATM)N��I TRDPERTY UNF S I <br /> DIfFO8A1 FONDS ❑WIDTH IENOTN DERN DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> 1 HEREBY CERTIFY THAT I NAVE PREPARED THIS APRICA7MN AND THAT THE WORK WILL BE DONE N ACGOWAANCE WITH SAN JOAOUN COUNTY 010E4WCE8 AND STATE LAMS.AND RULES <br /> AND REGULATIONS OF THE SAN IOAOUN COUNTY.NOME OWNER OR LICENSED AGENT'S SIGNATURE CERf►RB THE FOLLOWING;'I CVMWYT14AT N THE PETINOPPEANCE OF TNEWOIKFORWNICH <br /> THIS PERMITM SUED,1 SHAAL NOT EMPLOY ANY PERSON N CH A MANNER M TO BECOME SUBJECT TO WORKMAN'S COMPENSATION tAWB OF CAUFOMOA-' CONTRACTOR'S HBING OR Ov <br /> Ov <br /> SUR CO TWO N THE FOLLOWING: FY THAT N THE PEFWOFWA14CF OF THE WOPK FOR WHICH THIS PERMIT 18 ISSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> WONLM 'B COMPE TION WE C RN Ni••YtTfT-CALL 24 HOLM IN ADVANCE POR ALL MOWED DlI/B^PECTOIM. COMPLETE DRAmAN0 BRDW. <br /> SIONEO% <br /> POT PUN(DRAW TO SCALE)SCALE to 1 <br /> I. NAMES OF STREETS OR ROADS HFAAEST TO ORBOUN WING THE PROPERTY. 4.LOCATION OF HOUSE"WAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2.OUTLINE OF THE PROPENTY,WITH 01114009100111,AND NORTH DIRECTION. EXPANSION OF SEWAOE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED MENONED OUTLINES AND LOCATIONOF ALL EXISTING AND PROPOSED STRUCTURES. S.LOCATION OF WELLS WITHIN MONS OF ONE HUNOMD FIFTY FT.ON <br /> INCLUDING COVEMD A AS BUCK AS MTOE.DESVEWAYB•AND WALK$. THE FIRDPEETY OR ADJOEON FROPO". <br /> ..........._ ..... <br /> . .rte:.: <br /> .. .,.... ..c ...a.... .. o <br /> To_ cath-Uj .......... <br /> > i . °.... <br /> ..a......:... ... .e. <br /> - N <br /> �. ...:. . <br /> .`w _. ...,......g....a.....�....o-.....j.....:,....' <br /> 1 <br /> r;tr, F <br /> _. <br /> ..... ..... ...... ... ..i- .. <br /> ..... ... .. _ <br /> �. <br /> 3ut_ <br /> - - — <br /> .... <br /> W)CS�N)C/O IAN 1t3ACl ltvrCCfUN$V <br /> S LM�yJ S - PUgi!� EIEACTH SERWCES t <br /> 1 I <br /> .... _ <br /> -R4V1fiTrilAftTAtHEkLTW'f1t�kR1N e <br /> FOR OBARTMSIfi SUSS ONLY <br /> APPLICATION ACCEPTED BY DATE:, 30 4 .,, a <br /> TAW,PIT OR SUMP INSPECTIONBY DATE �`FWAL WMMCTMM BY/` - DATE 7 6 <br /> ,3014 <br /> ADDITIONAL COMMENTS: SBC--^/ .��•^-�-� — S ww/S .>ti -cX/S><z Nat /,GY7•GLCY7� _ _ __ _ <br /> ACCOUNTING ONLY: AIDE FACT <br /> NE CODE FEE INFO AMOU"ABIIRTW CNEC ASN RECOVFD BY DATE SR!$EMR INRMYI NVOIOt <br /> clsgvoo 2f.Qd;2 !LJ <br />