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APPLICATION FOR 111UI0:WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC"EALTH:SERVICES ENVIRONMENTAL HEALTH 0119SION P.O.sax 308, 446 N.SAI!JOAQUIN ST.,STOCKTON,CA 96201.9369 1209)4SO.3420 NON•REFUNDAM PERMIT EXPIRES 7 YEAR FROM I)hTg ISSOED Jr4ewIBtP i8 TripRTa6r) A AQUIN IONCO IS HEREBY MAGE T THE SAN JOAgU1H COUNTY FOR p E STAN TO CONSTRUCT ANDNR INSTALL THE WORT.DESCRIBED THIS APpLICAT30N,G MAGE IN COMpUAlUCE WITH SAN JOAOUW COUNTY DEVEIAPATEN/T TITLE,CHAPTER 9-T 1 70.3 AND THE STANDARDS OF SAN JOAOUIN COLRITy PLUHl1C HEALYH JOB ADDRESSMA APRT SERVICES,ENLRMNAIENTAL HEALTH DIVISION. / ~ —~Y � i. CTry / OWNEWS NAME /`r��,y- /,�,1�/ LOT +SIZ£ �•L5:!s 3 :a /JL;(,F_1,7r'A//A .+ - CONTRACTOR..C..�y� .Q ''/ ✓..f es c , _ALK RE8G1�C�qqi y 4 we i* .A Cus COMPACTOR IICS�'Y! -jU`PHONE ADpgEee LICr PHONE TYPE OF SFYTUC WORK: REw INSTALLATION❑ XFpANUAoomoN❑ DEZT*ILX'MN WO SEPTIC SYSTEM MWrrrED D PUBLIC SEWER M AVMs-ABLE WITHW 2W FEET OF BUILOIN6.1 PEAC TESYlTI I i/LORI MANY APPRa.p-r INSTALLATION WILL SERVE: RESIDENCE I, COMMERCIAL❑ OTHER O NUMBER OF LIVING UNITS: NLLMBBI OF SfDRGOMS: NUMBER OF■IZVE71: CHARACTER OF SOIL TO A DEPTH OFT�a FEET: FT MMP SOIL CHARACTER; WATER TABLE OEPTTI ZmTIC TANKPOREASg TWI--I 0 TYPEIMFO CAPACITY rro.COMPARTMENTS YRG TREATMENT PLANT ID DISTANCE TO NEAREST: WELL FOI/kDATION o.COMPARTMENTS LINE LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOGED Uy TEM) LEACPING VNE ❑ lip.A LENGTH OF LINES DISTANCE TO NEAREST;WELL W VNDATTON PR pERTY TINE FILTER eED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED 113�-3-I WIDTH LENGTPTHH DEDISTANCE TO NEAREST:WEU_FOUNDATION FMOPERry LW£ 1 &WAGE RTZ 1 DEPTH SLS NUMBER DISTANCE TO NEARE67:WEAL FOUNDATION TIry�y PROPERTY UNE 1..1 Awp/ WIDTH LENGTH DEPTH DISTANCE 70 NEAREST:WELL FOUNDATKIN p110R:RTY[RIE DISPOSAL PONDS M WIDTH LENGTH DEPTH DISTANCE TO MEANEST:WELL FOUNDATION PROPERTY LINE ---- I HERBY CERTIFY THAT I HAVE PREPARED THIS APR.LCATION AND THAT THE WORK WILL fE GONE W ACCORDANCE WITH SAN JOAQUIN COUNTT ORDINANCES AND STATE LAWS AND RULES Cs^T AMU REGULATIONS OF THE SAN JOAOVW COUNTY,HOME OWNER OR LICENSED AGENT'S MGNATURECERTiF¢S7NE FOLLDWHO;'I CERRFYTHAT IN THEPEWORMANCE OFTHIEWORK ED WHICH �I THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT To WORfMA"COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SU"DNTRACTWG SIGNATURE"METES THE FOLLOW W0:h CERTIFY THAT W THE PERFORMANCE DIP THE WOR(FDA WHICH THIS PERMIT IS 16SUED,1 SHALL EMPLGV PERSONS SUBJECT 70 WORKMALC'O'SATIO OF CALIFORNIA.-THE APPLICANT MUST CALL 2A NOURZ IN ADVANCE FOR ALL REGLAnm TNZpECTIONg.COMPLETE OMWBNB BROW.tJGNED XTFTLE:_�f.L,J�E/�' DATE: PLAN WRAW 70 SCALE,SCALE •La 1.HALES OF VAEET8 of'ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUBE SEWAGE DISPOSAL SYSTEM OR PRppOSEO 3.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTJON. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3.DIMENSNINEO OIITLWE6 ANO LOCATION OF ALL EXISTING AND PROPOSED STRUCTUFEFL S.LOCATION OF YVR1.8 WTTU{W RApRIg OF ONE HUMORED FIFTY FT-ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRVEWAY9 AND WALLS 'TNT PROPERTY CIR ., .. .1'RDI'CRTY. �. FT. ... .... ..: .,,.��...,... _ 1..._. I /J /: j JUL 1995 ... �.. >. - I✓f3 r' ..,., i �� ,-., }i1=AJ-1}+ OCE" t z r MF.rwrfiL �'A1ry ti)vis ;, ;.AUL ?3951 _ JGAQt,} rlhr. 1141 .faA!�LF ' TAI.F L,17Rf s tf L: Ua1, �IF?GNM�N FOR DEPARTMENT WE ONLY / y —z APPLICATION ACCEPTED BY GATE:_ J I { AREA: /I Gam. TA .FIT OR SUMP INSPECTION BY DATE / / FINAL INSPECTION BY PATE [-7 ADDRTONAE COMMENTS: _-'�� ACCOUNTINS ONLY: ARIr FACS R CODE FEE INFO AMOUNT REMITTSO EIEC UCABFI RECEIVED BY DATE FII f PTJONT NUMBER 1N VOICE a � 24,OU W530 a ./