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APPLICATION FOR LIQUID WASTE PERMIT R{4 8 'OAQUIN COUNTY PUBLIC HEALTH SERVICES 4 ENVIRONMENTAL HEALTH DIVISION a P.O. BO]( 308, 446 N. SAN JOAQUIN ST., STOCKTON, CA 95201.0388 1209) 488.3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED lComplato is TrlpIketal Application is hereby made to the San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with San Joaquin County Development Title, Chapter 9-1110.3 and the Standards of San Joaquin County Public Health Services, Environmental Health Division. Job Address/or APNO 552-.50 City 5rlk Lot Size 32c Ac4-�r3 Owner's Name ddress xZ STk Phone V42-?5-75- Contractor ME 42-45-75-Contractor/1lE L d• Ayo&�,( 9,40!'' 21-r-Address 22 n! IV CA- L1c# YY-41f f Phone)G7-'17"/ Sub Contractor Address L1c# Phone TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRiADDITION I I DESTRUCTION I j PERC TESTImA Now man; Z (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) /CJS 5 Y-33 Lend Use Appiieatloa / Installation will serve: Residence Commercial other Number of living unites Number of bodroomes Number of employeatt jl� ,/7 Character of Boll to a depth of 3 foots PItJSump Spil acter: Water Table Depthi �._ +4 SEPTIC TANXJGREASETRAP I) Type/Hfg Capacity No. Compartments PKG TREATMENT PLANT [ 1 Distance to nearest: Well ��jy/—f Property line y for (enclosed system) LIFT STATION[] Size T LEACHING LINE [1 No. IL length of lines J�� .CF — Foundation Property Line FILTER BED [1 Width Length Depth ` Foundation Property Line Foundation Property Line MOUNDED [I Width Length Depth, SEEPAGE PITS [I Depth Size Number_ /f'Fdc,�s�iy��K / Foundation Property Line SUMPS (1 Width Length Depth_ "v ~/l1-_,rj Foundation Property Line DISPOSAL PONOS t1 Width Length Depth " " Well Foundation Property Line i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances and State Laws, and Rules and Regulations of the San Joaquin County. Home owner or licensed agent a signature certifies the following : "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such a mamer as to become subject to workman's.compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that In the performance of the work for which this permit is Issued, 1 shall employ persons subject to workman's cononsation laws of California." The appDsaot must al 4 house is adva r dl rrqulrad Inspaat[ons. complete drawing below. Signed X O Title: 111116-3. Date: // 7A PLOT PLAN (Draw to Scale) Scale " to 1. Names of streets or roads nearest to or bounding the property. 4. Location of house sewage disposal system or 2. Outline of the property, with dimensions and North direction. proposed expansion of sewage disposal syet . 3. Dimensioned outlines and location of sit existing and proposed 5. Location rt watts within Ing radius roiu sty 150 ft, on structures, Includi- ^mar the y p-- and walks. 9 17.5o AG.f yul Z _ I Z' t 3750 AG. 37.SoAc.� 31.50 AL �1GInG' r M � c.♦.34 A� Gt ..530.��.�o I L7S0�`'�c•?.-,-�I t7:o_ _ '�' 4'� �� -tI�.yn.-�350.�'� _r t.9I -.;.� o-rt•L25 A1 2.5 23 2G i Av 31 Sr,AG` 3i,5o AG' C / n sr N tlw\v Application Accepted by Date: Area: r V Date Final inspection by Date Tank, Pit or Sump inspection by —�� Additional Comments: ACCOUNTING ONLY: AID# FAC# PE CODE FEE INFO AMOUNT REMITTED CHECKflCASH RECEIVED BY DATE SR I PERMIT NUMBER INVOICE i UzzE o b o