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APPLICATION FOR LIQUID WASTE PERMIT <br /> k / SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON.CA 95202 <br /> (209)468-3420 <br /> NDN-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ICBmPIetE In Triplieatel <br /> AIPLIU—ON IS HEREBY MAOE To THE SAN JOAOUIN COUNTY rOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WCW DESCRIBED.THIS APPLICATION IF MADE IN—MP MA F WITH SAN <br /> JOAOVIN COUNTY DEVELOPMENT TITLE.CHAPTER 8-1110.3 AND THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICEA,ENVIRONMENTAL HEALTH DIVISION. <br /> _ _ - _. <br /> JOS AOURESRlD0.ARL/ CRY tP7 SIZE <br /> DI'1,.��= <br /> . OMER'S NAME I f + -}"!.. _ADDRESS _ RHONE <br /> CONTRACTOR ADDRESS L1GT PHONE_' <br /> GUBCONTRACTOR ADDRESS UC• PHONF <br /> TYPE OF SEPTIC WORK:- NEW INSTALLATION CJ` REPNIVADDRIDN CI b"TRUCTION❑ ` <br /> 111_ INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVNLAELE WH HTN]DO FEET OF BPIUXNO.lFPEND TF2TIrl I 1 NOW MANY <br /> APd mae a <br /> r� 1NSTAEGTION WILLSERVE: RESIDENCEO COMMERCIAL T7 OTHER <br /> 1t MARRED OP WINO MTS: NrAMSEN OF BEDROOMS: NNMBBI OF EMPLOYEES: <br /> CHARACTER OF BOIL TO A DEPTH OF S FEET:.~. --.�1 r r Lr•-r+'PITMUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> PIU <br /> SEHC TANDIIEASE TRAP 1]TYPEIMFOr! I/r,%'r- CAPACrrY / rr NO.COMPARTMENTS <br /> PRO TREATMENT PLANT 11 DISTANCE TO NEARUT:! WELL FOUNDATION 'f- PRPPEM LINE <br /> UIFT STATION D WE TYPE OF PUMP y+-I SAND OIL SEPARATOR(ENCLOSED SYSTEM( <br /> LEACMNO UNE IZI.NO.B LENGTH OF LINES -� DISTANCE To NEAREST:WELL .' FPRO <br /> OUNDATION i PERTYLJNE <br /> _y FILTER BED ❑WIDTH LENGTH •DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> Ma Moro ❑WIDTH LENGTH DEPTH DISTANCE TO NEARIEST:WELL FOUNDATION PRPERTY UNE <br /> SEEPAGE RTS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WCLLFOUNDATION PPOPERTYUNE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREGT:WEU- FOUNDATION PROPERTY UNE <br /> DISPOSAL PONDS D WIDTH LENGTH DEPTH DISTANCETO NEAREGT:WELLFOUNDATION PROPERTY UNE <br /> +. N <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPL1CATtRN'AHO THAT THE LVOWr WILL BE GONE IN ACCORDANCE WITH SAN,OAOVIN COUNTY OPDINAJICE6 AND"ATE AWS,AND RVLEB <br /> ANOIIEOULATIONBOFTHESAN.IOAWIN000N7Y.HOME OWNER OR UCENBED AXIENT'sm*NATVRE CERrIFIEB THE FOLLOMNOI'I CERTIFYTHAT M THE PERFORMANCE OF THE"w FORWINCH <br /> THRS PERMIT IS(SALEM I BRA"NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORLMANT COMMNSATWN LAWS OF CAUFORIIA.-CONTRACTOR'S WRNS OR <br /> SU&CONTRACTING SIGNATURE CERHFIEB THE FOLLOWING:9 CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO CR <br /> r WORLMANT COMPEENNSATRON LAWS OF CAUFORMIL'THE APPLICANT MUST CAL(N HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS.COMPLETE DRAVANO BELOW- <br /> SIGNED X <br /> ELOW.SIONEDX I I"41 \ C- .�� .- �'311i TITLE:, r <br /> PLOT R AFI(DRAW TO SCALE!SCALE-- <br /> 1. <br /> CALE 1.NAMES Of RTRFFTS OR ROADS NEAREST TO OR SOUNDINO THE PROPERTY, A.LOCATION OF HOUSE BEWAOE DISPOSAL SYSTEM OR PRDPOSLD <br /> Z.OUTUNE OF THE PROPERLY,WTTH DUMENSONS AND NORTH DIRECTION. EXPANSION OF BEWAOE DIBPOSAE SYSTTMS. <br /> 3.OIMENSIONEO OUTLINER AND LOCATION OF ALL EXISTING AND PROPoSED STRUCTURES 6 LOCATION OF WELLS YW HIN RADIUS OF ONE HUNDRED FIFFY FT.ON <br /> INCLUDIHO COVERER AREAE SUCH AB PATIOS,DRIVEWAYS,AND WAE1C6 <br /> THE PROPERTY OR ADJOINING PROPER". <br /> (r <br /> 7 r <br /> Fi <br /> I _y.. ..� qaw� <br /> rH'^F�1 <br /> .. y FEB-2.41999_.. <br /> I ; .... i. Imo- i <br /> .... - .. sn R.'IJ 4 cJU�f <br /> .,. 3 N 1 4 F T <br /> fl <br /> .... ... ..,, ., .,,. ... ...._,_. .. ....... awAn vrui�a ir=e h�vs <br /> .... <br /> $ Ir. <br /> ., <br /> �w <br /> F 11 <br /> .;--- .... ........ r r..�.��--� <br /> F7 - .. .. <br /> �I <br /> f <br /> F <br /> v <br /> F <br />