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[''?PLICATION FOR Liam WASTE PERMIT SAN':JOAQUIN COUNTY PUBLIC HEALTH SEk CES E ENVIRONMENTAL HEALTH DIVISION 304 EAST WSBER AVENUE, STOCKTON, CA 95202 (209)468-3420 NON-REFUNDABLE PEATRIT EXPIRES I YEAR FROM PATT ISSUED (Compht@ M TtiplintBl APPLICATION IB HEREBY MADE TO THE BAN JOAQUrN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH BAN JOAOIRN COUNTY DEVELOPMENT TITLE.CHAPTER 8-1114.3 AND THE STANDARDS OF BAN JOAGUIN COUNTY PUBLIC HEALTH BERVICEB.ENVIRONMENTAL HEALTH DIVISION. ��•�� JOB ADDRESS/OR APN 1 q U l -o CITY I Y O C l A- LOT SQE �.�/► jG1r) YN fOnL P1C' CL PIONE�r YYIZ1400 OWNER'S NAME I I I LJ<t]LO I i U -�i'GI:QUC. S�nADO77RE58 �/ t I As>4RESB Gc•7 h�1 1�1 U(�Stet��1 LICE PHONES_ CONTRACTOR -i_ J,�, / /f�,C /��•+ �y� .•SUYCONTRACTOR ADORES@ N�G7f lh 4'/ r {,S"F—LY 1 �i LICKS PHONOVEM I TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ DESTRUCTION D INC SEPTIC BYBTEM PERMITTED W PUBUC SEWER 18 AVAILABLE wimm 200 FEET O UR.m"mi PEIIC TE�-= W MANY APpN INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIALS OTHER❑ NUMBER OFltVINO ITNtTB: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: L CHARACTER OF BOW TO A OEM OF 3 FEET. PITISUMP SOIL CHARACTER;. WATER TABLE SEPTIC TANKIOREABE TRAP ❑TYPEIHIFO CAPACTIY NO.COMPARTMENTS PKO TREATMENT PLANT 13 DISTANCE TO NEAREST: WELLFOUNDATION PROPERTY UNE tIFT STATION❑ SrZE TYPE OF PUMP BAND OIL SEPARATOR(ENCLOSED SY8TEMI LEACHING LUNE ❑ NO.A LENGTH OF LINES DISTANCE TO NEAREST!WELLFOUNDATION PROPERTY LINE FILTER BED ❑WIDTH UENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED 13WIDTH LENGTH DEPTH DISTANCE 70 NEAREST:WELL FOUNDATION PROPERTY LINE CEWAGE PITS ❑DEPTH 82E NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LONE SUMPS ❑WVTH LENGTH DEPTH DISTANCE TO NEAREST!WELL FOUNDATION PROPERTY UNE — DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE_ 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES NS OF THE BAN JOAOUIN COUNTY.NOME OWNER OR LICENSED AGENVO SWNATURE CERtWMB THE FOLLOWING:'I COMFYTHAT INT14E PERFORMANCE OF THE WOW FOR WHICH /4HD AEpULATIO THIS PERMIT NS OF 1 SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME WBJECTTO WORKMAN'S COMPENSATION LAWS OF CA POWA.* CONTRACTOR'@ HIRINO OR BUS-CONITUICTINO SIGNATURE CERTIFIES THE FOLLOVNNG:I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR W=H THIS PERMIT IS ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO WOWCMAN'S MPENSATION LAWS OF CALIFORNIA.* THE APPLICANT MUST CALL M HOURS IN ADVANCE FOR ALL RIIOUAm INSPfCTTONS',1COMP-LtETE DRAWrNo aEUrllf. STONED x IV Pa ti' SQL, __TITLE:, a[p l s / 0/15U�1{111!DATE, PLOT PLAN roRAw TO SCALE)SCALE YI ! 1. NAMES OF BTREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. ..- -.. 4..LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WrTH DIMENSIONS AND NORTH DIRECTION. EXPANSION LO A TION F SEWAGE THIff'DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL fXISTTNO AND PROPOSED STRUCTURES, B.LOCATION—OF NIECES WTTHBM RADIUS OF ONE HUNDRED FIFTY Fr.ON _---"_--._ "^"'NO PROPERTY. HC ILVDSTO COVERED AREAS SUCH AS PATIOS —`•'"------- _ _ - v, . ....'.-- onSnsErncrnw k, TO ME MEP Ff ti ...,..........:............. ..... ......... .. .. ..................s...... - ,.............<...... • :...... .. . .. .......:.....................:.......:..... O&A l E i« G .... .,... rExcolnna"r+TEer ................. ....................:............ - ..... � T lEAcl+rLLo To ME REMOVED .SEP . ;._,.,E...... oeo roe �At/tC� _ EX[5nWLE WFreto ` 4ltw l �MGEME7FflE5Gk_r. ruv� +vMNtEAkr. , >. .,........ FOR DEPARTMENT USE ONLY DATE: r AREA: �r APPLICATION ACCEPTED BYor L� / DATE I L_FINAL INSPECTION By DATE TANK.PIT OR SUMP INSPECTION BY '9.4` Ka OIT ADIONAL COMMENTS:— ACCOUNTING ONLY: AIOf FACS' 'PE CODE FEE rNFO AMOUNT REMIITED CIPEC ABH RECEIVED BY DATE on I PE NST NUMBER INVOICE f 2�t5701" (� I.P� llv q Pub.Health Serv.•Emlro.174(3196)