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f,-. <br /> 'APP CATION FOR LIQUID WASTE WHIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH$EiAiMj:� <br /> yyI ENVIRONMENJAL HEALTH DIVISION E?, <br /> 446 N.SAN JOAOUIN 8T,STOCKTON,CA(,t201 0388 <br /> Slwl j'"t` �`yL1� ys. (209)468.312D v <br /> � <br /> yl NONREFUNDAELF PERMIT EXPIRES I YEAR FROM DATE ISSUED .t i � <br /> rC 6ta Y Tripseem) 1 <br /> Application Is hereby rode to the Sen Joerluin County for a permit to construct end/or install the work described. This application <br /> is made in compliance with Sm Joaquin Canty Development Title, Chapter 9-1110.3 and the Standards of San Jospin Canty PWUe Nealth <br /> Services, EnvRoroente Wealth Division //- y1 <br /> Job Address/or APG# 72 City"//(// Lot Size <br /> Owner's None Address 7J , t.r-' �Z PhmJ- d.s-411yla3f, <br /> Contract Address,40_04Licr Zz Phone 'S�ds <br /> Sub Contractor A ress Lice Phone <br /> TYPE OF SEPTIC WHISK: NEW INSTALLATION 11 REPA OI110N>< DESTRUCTION 11 PERC TFV6.)I I Naw na y <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEVER 15 AVAILABLE WITHIN 200 FEET OF BUILDING.) <br /> nn�_ C l /I Lead U.Apsladma e <br /> Insus <br /> lAatlon will nerve: Residence_ Commercial ^ Oth<r�C1eGt�, �J./� <br /> laaber of Living unitat_ Naber of adroon Muster of vryloyenn_ / <br /> Character of soil to • depth of 3 fes }F{Sup Soil Characters Yater Table I0 <br /> SEPTIC TARMGREASE TW D Type/Mfg Caped ty No. metsPAN TREATMENT PLANT I 1 Diste.e to.erect: Well Foundation PrineLIFT STATION[) Size_ Type of-Pis'p Send Oil Separator (enclosed systm) <br /> LEACHING LINE I] No. S lath of Lines Distance to Nearest: Yell_ Foundtion_ PLim 1FILTER RED I] Width_ Lath_Depth_ • " Vel I_ Foudation_ PLimtl0UN0ED (] VidthLmpthDepth • " YeLIFpundatiorL PLim ,SEEPAGE PIT$ Depths SizeNumber • " /rdl'e11�/U/r'-Foudat(m /b f PLine I'SUMPS IT Width_Length_Depth • " YeLI_ Foudation_PLine <br /> DISPOSAL PONOS U Width_ Length_Depth_ ^ ° YeLI_ F.udatf on_ Property Line <br /> — <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Sm Joaquin County Ordinances <br /> and State laws, and Rules and Regulations of the Sm Joaquin Coady. Hann omer or I Icereed agent's signature certifies the following <br /> •1 certify that in the perform.e of the work for Which this permit Is Issued, I shdL .t aploy any person in such a manner as <br /> to become subject to workman's coapermation Laws of California." Contractor's hiring or sub-contracting signature certifies the <br /> following: al certify that in the performance of the work for which this pamit Is Issued, I shill employ persona subject to workman's <br /> caipensation laws of California." <br /> TheeNO., 4 24 rasa for aD required Inpeed m. Complete drawing below. <br /> Signed X — Title: 00. <br /> 611 � PLOT PLAN (Drew to Scale) Scale_- to <br /> 1. Nurses of straps or roads nearest to or bonding the property. 4. Location o1 house sewage disposal system or <br /> 2. Outline of the property, with dimensions and North direction. proposed expars ion of sewage disposal system. <br /> 3. Dimensioned outlines and location of all existing and proposed S. Location of wells within radlus of 150 ft. on <br /> structures, including covered areas such as patios, driveways, the property or Adjoining property. <br /> and walks. <br /> 1 / t <br /> 199h I <br /> SA J0Q0 CO NTY <br /> AlH lT' I iuw <br /> �PoR DEPARTMENT USE ONLY <br /> Application Accepted by (XJLu/�+'--sf�— a Date: /O Area: Z/ Z <br /> I or Sup Inspection bye e(� DsI7/&/k0(.L inspection by <br /> Addi anal Cmnenb: 6 f <br /> rT4e f0, e - oy4kqse, <br /> ACCOUNTING ONLY: AID# FAC# <br /> ..ted <br /> PE CODE FEE INFO AMOUNT REBUTTED Eq( W SN RECEIVED BY DATE NRF PERMIT NUMBER INVOICE e <br /> l?'v -Qa 15V a <br />