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A ;ATION FOR LIQUID WASTE PERMIT SAN JWQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 446 N. SAN JOAQUIN ST., STOCKTON, CA 962010388 (209I 4683420 NON-REFUNDARLE PERMIT EXPIRES I YEAR FROM DATE ISSUED ICompbt{ in Trlp6E{toI T UION IS HEREBY MADE TO TEIE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE W01K DESCRIBED. TING AAT ICATION 16 MADE IN COMM IANCE WITH SAN 1, =COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 ANDTHESTANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. IS ADORESWOA APNI _ --)- +::AP> ,::z '+L'`9 a CITY Y�.Cah)rr•!l-: LOT SIZE 1_ I'�Qi') I S NAME CC.V\L-\1C Hwa 1. 1'I ADDRESS v1Y).SCJ �•t-, /�yJi_ RHONE )N.+.�CTOR f. i[_ S_ii.<L.-\ . -ADDRESS�`j'��\ ��\E -Y M..a \ ]� I LIC/ ''k OP; RHONE .jf.S 3`i3i -ONTRACTOR \ ADDRESS 1I�' UCI NIONE - SEPTIC WORK: NEW INSTALLATION [IREPAIRADDITION Vi DESTRUCTION ❑ J SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING) 8310 TEATI.I I I HOW MANY E App"..BUR E s ATION WILL SERVE: RESIDENCE E7 COMMERCIAL 13 OTHER ❑ WOO OF"NO UNITS:�I NUMBER OFDROOM{: � NUMBER OF EMPLOYEES: Cl/ IE^SCTER OF SOIL TO A DEPTH OF 3 FEET: U EI-F RT/SUMP BOIL CHARACTER: LhU J>w.<aI WATER TABLE OEPFI! T TANOOREASE TRAP TYFEAMFG CAPACITY NO.COMPARTMENTS IJ L_JITMMT PLANT❑ DISTANCE TO NEMEJT: WELL FOUNDATION PROPERTY UNE U1 UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEMI (1 a IO UNE E9_ NO.S LENGTH OF LINES / OC. C) ) F DISTANCE TO NEAREST:WELL_FOUNDATION�')t PROPERTY LINE /L C+ F Q IED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE_ 13 OUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION FRDKETY UNE V 1 E TE RTS ®DEPTH SIZE "�T f U" HUMBER__L_DISTANCE TO NEAREST:WELL FOUNDATION 1 PROPERTY UNE_Z/f)+ ❑WSTTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE ` SPUDILI PONOS ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELD FOUNDATION PROPERTY LINE I ^ CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES T\ It ULATION6 OF THE SAN JOAQUIN COUNTY.HOME OWNEROROCENSED AGENT'S SIGNATURE CERTIFIES TREFOLLOWING:'(CERTIFY THAT INTIIE PERFORMANCE OF THE WOR(FORYOIICIH /v 9. MIT 15 ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING O1 0 eMTRACTING SIGNATURE CE��{TTIFIE6 THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO ORtMKN'6 COMPENSATION OFhAZFONlA.' 111E APPLICANT MUST GAIL 211gUR{IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. - _ ///1 _(n`.�<///p/ TITHE:-&L 2 n DATE: PLOT RAN STRAW TO SCALE)SCALE •1P ES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY, t. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED INE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. uS�.N610NED OUTLINES AND LOCATION OF ALL EXISTING AND PROMISED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AB PATIOS.DRIVEWAYS,AND WALKS. THE PROPERTY DR ADJOINING PRORERTY. O 1' L-tw�w I_ Arlt 2'5 "IJ`'ii (I - IIJLH IJLA( IF rRVIH INisFhl l'r•. I �� .