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APPLICATION FOR LIQUID WASTE PERMIT SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES 1NVIRONMENTAL HEALTH DIVISION P.O.BOX 388, 446 N. SAN JOAQUIN ST., STOCKTON, CA 962010388 (209) 4683420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED APPLICATION IS HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A FERMI TO COCNSTRIUGI AND/OA INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAGUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOUIN COUNTY HE WOLIC HEALTH SERVICES,ENVIRONMENTAL I HEALTH DIVISION. JOB ADDRESSMA APNI 9147 Thornton Road OWNER'S NAME Joe Chau c, Stockton lacre 3849 Delano Ave. Stockton, Ca. 95204 LOT3 ADDgess 462-366 68 Don Lawley Co., Inc. CONTggCTOR 2710 Loomis Rd. Stockton nloryE ADDRESS IAF 621509 466-8088 SUB CONTRACTOR None PHONE ADDRESS LIC4 M/ONE TYPE OF SEPTIC WORK: NEW INSTALLATION❑ RE !q DTION ❑ INp SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 1000 FEETFEET OFF BVILDING.1 (A DFSTRUCTION P9RC TESTI.)1 1 HOW MANY INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL❑ APPBo.dn OTHER❑ NUMBER OF LIVING UNITS NUMBER OF BEDROOMS: NUMBER OF E.LPLO YEEB: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: MT/SUMP SOIL CHARACTER: SEPTIC TANK/ORFASE TRAP TVFlE/MFG WATER TABLE DEPTH CAPACITY PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL No.COMPARTMENTS FOUNDATION --" UFT STATION ElSIZE TYPE OF PUMP PROPERTY UNE SAND OIL SEPARATOR IENCLOSEDS :WILLSYSTEM) LEAC HNO UNE ❑ NO.N LENGTH OF LINES DISTANCE TO NEAREST:WELL FILTER BED ❑WIDTH LENGTH FO VNOATION PROPERTY UNE DEPTH DISTANCE TO NEAREST:WELL MOUNDED ❑WIDTH FOUNDATION PROPERTY LINE IENOTN DEPTH DISTANCE TO NEAREST:WELL SEEPAGE PITS ❑DEPTH FOUNDATION PROPERTY LINE SRE NUMBER DISTANCE TO NEAREST:WELL SUMPS ❑WIDTH FOUNDATION PROPERTY LINE DISPOSAL PONDS LENGTH DEPTH DISTANCE TO N EAREST:WELL FOUNDATION PROPERTY UNE ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELI FOUNDATION PROPERTY LINE 1 IIEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES ANO STATE LAWS,AND RULES _ T AND REGULATIONS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT IN THE I`EgfORMANCE STATE THE WOW.FOR VRUL ES TSUR HIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR WORKMAN'S OM SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WOO(FOq WHICH THIS PERMIT A ISSUED,1 SHALL A.- OV PERSONS SUBJECT TO WOR(MAN'S COMPENSATION LAWS OF CALIFORNIA." THE APPLICANT MUST CALL 24 MOMS IN ADVANCE FOR ALL REOURED INSPECTIONS. COMPLETE ALL EMP BELOW. SIGNED% TITLE:_ Bookkeeper 3-13-95 GATE: C ROT RAN(DRAW TO SCALE)SCALE l 11 60 I �) 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. --� 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. Io4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED ct3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, EXPANSION OF SEWAGE DISPOSAL SYSTEMS INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON J — --- THE PROPERTY OR ADJOINING PROPERTY. LuoLE AVE. N CD 0 1-tULLSE -�' D F : APPRoX a t'571,JZ D 140/ C:) z 1 Nous Z PA1F15F-NT 7v 0 F!Jtl'1 IJ111{.t 11111(. SEPTI(- TAuV_ QUI il)ts�lr:�i4r1(il�;lt '1 f'•; ENAKIM"A"liftLlIe�tI11lrl i%h7l FOR DEPARTMENT USE ONLY AM'LIf,AT10N ACCEPTED BV DATE: TANK.PIT OR SUMP INSPECTION By AREA: ATE / / FINAL INSPECTION BY ADDITIONAL COMMENTS: � DATE / � /9� �kI C Ln ACCOUNTING ONLY: AID/ � PE CODE FEE INFO AMOUNT REMITTED CHECK//CA84A1y� VV RECEVED BY _—E W (l J /PERMIT NUMBER I r_ + INVOICE