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i i APPLICATION FOR LIOUIO WASTE PERMIT i SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 445 N. SAN JOAOUIN ST., STOCKTON,CA 95201-0388 F; (2091408-3420 i NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUES Mompists in Trokap) APPLICATION 18 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE INCOMPLIANCE WITH SAN I JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC CHEALTHRVICENT HEALTH DIVISION. JOB ADDRESSIOR APNr SIZE F1 ` PHONE -G OWNEWS NAME ADDRESS I CONTRACTOR __ dS � ' ss ��-�{'Z69 s_' LICr �PFLONE�_ 5UB CONTRACTOR ADDRESS UC# PHONE IC TYPE OF SEPTWORIU: NEW INSTALLATION 13 RED - N DESTRUCTION IND SEFTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTM I I NOW MAW Appkedon r ' INSTALLATION WILL SERYL: RESIDENCE COMMERCIAL 13 A OTHER 13 NUMBER OF DING UNITS:-_NUMBER OF BEDROOMS: _NUMBER OF EMPLOYEES: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: r y Prr=MP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC ®�• TANKAIREASE TRAP TYPEnMFG Ert G _ CAPAM 1 b o0 NO,COMPARTMENTS -- PKG TREATMENT PLANT 11 DISTANCE TO NEAREST: WELL FOUNDATION 14a / PROPERTY Lw--.5—! LIFT STATION 13 SRE TYPE OF PUMP SAND OIL SEPARATOR{ENCLOSED SYSTEM} LEACHING UNE NO.S LENGTH OF LINES a - g A/ DISTANCE TO NEAREST:WELL,,,,_FOUNDATION PROPERTY LJNE—m� FILTER BIER ❑WIDTH LENGTH DEPTH DISTANCE To NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LLNGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE PIT$ ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION - PROPER.V LINE SUMPS 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISDOM PONDS O WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WO RK WILL BE DONE IN ACCORDANCE WITH SMF JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES rAND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOMEOWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:"I CEATIFYTHAT IN THE PERFORMANCE OF THEWOFK FORWHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S H1Rim OR I SUBCONTRACTING 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 i• WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. F SIGNED X TTTLE: DATE:T PLAN tDRAW TO SCALEV SCALE '0 n 1. NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED +I 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION EXPANSION OF SEWAGE DISPOSAL SYSTEMS. I } 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, E. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED MEAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS_ THE PROPERTY OR ADJOINING PROPERTY. ......... ....... --- .......... - ............. .... -- - ... .---.. ....... -..... . ......... ............. . :...... :-. - .. : _ - .. .. � ,� ................. ........ .......... m..... 1 ` F ... .......... ..... ....... .. ... ....... ......... ..... ;. .. . . i . ............ .......................................... 1 f... ...a� . :.............. _ -----. - .... - .. [ . .................................. .................. .................... ........... ........................ .-. ..:. ................ ..... .... ... .....,................, .. .....: IRS . ,. .. V :............ ... . v. , �1N 2 199 . - .. ..... . ........ HI ALTt 5E {uICS ... ...... Bf IC' s ENil1RONMEIVTAL HEALTH D1Vi5[0l ... ;:. ....: :.. .