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TI_ICATION FOR LIQUID WASTE PERMIT <br /> SAN'75AOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> RO, BOX 3Ma SCA EAST WEREA AVENUE, STOCKTON, CA x@1-388 <br /> [2991 458.3420 <br /> NON-REFUNDABLE PEEfMly EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Trlpilentsi <br /> t 1,ATIOhj IS HEREBY MAM TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOW DESCRIBED. THIS APP/JCATION IS MADE iN COMPt Ij�e,•::F <br /> VIAN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110-3 AND THE STANDARDS OF SAN JOACUrN COUNTY PUBLIC HEALTH SERVICES,FIMROHMFNTAL HFALTH tI'A .n.4 <br /> t �- - 1 _ � t <br /> r, urs,rr., Rel � ���.- b - eFrr C- . -- -— DAslet <br /> N&JAF ADDRESS <br /> ft4;_--- Cove- - •C ----ADDAESS�j?_. 4�5- /7-l/Sz`- 97% LIG. YY"T12� PHbHZ S�G3'S 37 3 <br /> lC= SPI+TIr wome, NEW INNTALLATLON I P"ANVADMVHM DESTRUCTION <br /> ;r"1 r S'ST);M Pf FOAHTEl1 IF PUbUC SEWEH IS AVAILABLE 4VIiFHN TOO FEET OF BUILDING.) 1'610 TFSTW 1 i 4OW 11AfaF I <br /> lipaYcx�ir•. s <br /> I- C'dMMEP.I:lAL 0 OTIEFR 11 <br /> n3 11..,•., r.!,�,i•s:_.._,./__ WIPARER OF BEDROOMS- PCNUM!!ER OF FJMPt.0yus: —_ r <br /> ''A ISC3T!i3!`F-3y FEET:_ GC YYIP/SUMPSOIL CIiAAACTFR:___._�_,�._..._.r_.__ieVA1iiR'iAPtf DE�fi <br /> 4PAF LJ T YI'i/I.tl"G- C:APACTIY ` HO.00MPARYMEM-'^o --.:.__... .._ ( ►� <br /> rs.rATPAFHT MANY ❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE_W__ <br /> UFT STATION❑ SIZE TYPE OF PUMP _1l,SAND/Olt SEPARATOR(ENCLOSED BYSTEMI <br /> CHNQ LINE NO.1 LENGTH OF UNES��IQO7 r7YLQYb2 e, DISTANCE TO NEAREST:WEIR FOUNDATION 7 CEJ PROPERTY UHE !�_E1_'_r_' —c <br /> HR SED 11 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY EINE^T _ <br /> V� <br /> UNVED ❑WIDTH LENGTH H <br /> DEPT _DISTANCE TO NEAREST: U <br /> WELL FOUNDATION PROPEMY NE- - -----T <br /> PAGE RTS ❑DEPTH SQE NUMBER DISTANCE TO NEAREST:WELLw_�_ -FOUNDATION PROPERTY UNF--..�__-.. <br /> APS 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> POSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST-WELL FOUNDATION PROPERTY <br /> REBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE N ACCORDANCE WITH SAN JOAGLN COUNT ORONANCES AND STATE LAWS.AND RULES <br /> )REGULATIONS OF THE SAN JOAQUN COUNTY.HOME ORUCENSED AGCW'9 0GNATURE CERTIFIES THE FOLLOVAINO:-ICERTIFYTHAT N THE PEF"fWAHCE OF THE WOE/(FOR V01WH R <br /> 6 PERMIT 19 ISSUED.1 SHALL NOT EMPLOY ANY PERWN N /MANNER NNER AS TO BECOME CUBJECT TO WORKMAN'S COMPENBATIV I LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR OV <br /> I-CO G WTURE In*FOLLOYW,IO: C THAT N THE PERFORMANCE OF THE WOW FORWHICH TEAS PURIST IS tSSUED,1 SHALL EMPLOY PERSONS SUBIECT TO <br /> FILM 'S CO OF IFORNIA` THE T MUST 0141 24 WAM IN ADVANCE FOR ALL PWAIL IE{Df�(fIM�LTtONs- COMPLETE DRAVVM BELOW- <br /> I3V"C+K <br /> � <br /> TITLE^ -OL DATE: <br /> PLOT PI AM IGRAW TO SCALE I SCALE <br /> -t,;i)s-s L I+)'r I'S OR ROADS NEAAFST TO OR BOUNDING THE PROPERTY- J. LOCATION OF HOUSE SEWAGE 01,'W03A1 SYS i 0 :-.:. f <br /> ^�•-lt 5r4f f)1;1 H{'Iu)PCFtT y,'AV H DIMENSIONS AHD NORTU DIhcCY VON. EXPANSION OF St-iNA3E DISPOSAL BYSTEMS. <br /> I':I.{FNS{ryNTi)OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED HTRI)CTIJRES, S. LOCATION or LVfLLB Nr{THIN RADI{JB OF ONE Iil ur{ rlF"L <br /> 'J.LUOING COWREO AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKII. THE PROPERTY OR ADJOINNIG PROPERTY- <br /> _ <br /> s 3 N "� f 1;Z <br /> �i <br /> -- <br />