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APPLICATION FOR LIQUID W' 'E PERMIT 'SAN JOAOUIN COUNTY PUBLIC _TH SERVICES ENVIRONMENTAL HEALTHIVISION P.O.BOX 388,446 N.SAN JOAOUIN ST.,STOCKTON, CA 96201.0388 (209)468.3420 +.' NON-REFUNDABLE PERMIT EXPIRES i YEAR FROM DATE ISSUED (Complete in Triplicate) Apptication 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 APNM 1477 City f1T Lot Sixe_ eJ��S Owner's Nome�py-t{�q,�-t +ry,-) �- .y^p�k Address Phone Contractor�y-�'_ '�ay,-jD, Address 5 � 5 1g1�/,J, Lfc# Sub Contractor Address Lic# Phone TYPE OF SEPTIC WORK; NEW INSTALLATION 1 I REPAIRIADDLTION lo- DESTRUCTION I I PERE TESTI.(L 1 How mea.— _ (NO'SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) Installation will serve: Residence_ Commercial '/ otherlad Use Application 1_ Number of tivfng unitam_ KulOor of bedroomam_ Number of employees; Character of soft to a depth of 3 feet: pit/Sump Sat Character: Water Table Depth Ia C- m StPUL1"LKGREASE TRAP f] Typo/Mfg (` Qi l'yVm�i Y t __ I�L.�c_� ca ecl �No. Compartmente�4 P PKG TREATMENT PLANT I 1 Distance to nearest: Well Foundation Property Llne LIFT STATION[] Size � Type of Pune Sand Oil Separator (enclosed system) LEACHING LINE >LL No. A length of lines tf 1S^b' �_ Property Line / [ I) � �T_T_ Distance Nearest: Well Foundation72r_-1 FILTER RED 11 Width Length Depth acf /`"&m�j�? Well Foundation Property Line J �- MOUNDED [1 Width Length 11 Depth Well Foundation Property Line U SEEPAGE PITS W Depth 2%:�Size_A Number_ Well/� �>, Faurdation_� Property Line d" ' // r SUMPS [] Width Length Depth " �� `Yell dO-`� oundation Property Line - ar DISPOSAL PONDS ❑ Width Length Depth " well Foundation Property Line Q Z I hereby certify that I have prepared this opptication and that the work will be done in accordance with San Joaquin County Ordinances(- and State Laws, and Rutas and Regulations of the San Joaquin County. Home owner or Licensed agent's signature certffies the following "I certify that in the performance of the work for which this permit is issued, I shad not employ any person in such a msm r ac to become subject to workman's compensation Laws of California." Contractor's hiring or sub-contracting signature certifies the`c following: "I certify that in the performance of the work for which this permit is issued, 1 shad employ persons subject to workman's, compensation laws of California." The applicant mast caD 24 Roan In dv we for ail r►Auird Lnapadioae. Complete drawing below. Signed X Title: Date: L1— PLOT PLAN (Draw to Scale) Scale " to I. 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 systems. 3. DIImnsf oned outlines and location of sit existing and proposed 5. Location of wells within radius of 150 It. on structures, including covered areas such as patios, driveways, t e property or adjoining property. and walks. 0,4 Gy-t-'- n o s t a -Ya ti PYMIFN7 �u U; r, �� NM N7A HE LTH f!ice FOR DEPARTMENT USE ONLY Application Accepted by rte•-Cc.�.,— Date: 1-714S— Area- / Tank, Pit or Strop Inspection by Date / [ Final Inspection by m Additional. Comments: r,-e Zv-O ACCOUNTING ONLY; AID# FAC# PE CODE FEE INFO A UNT REMITTED E N ASH RECEIVED MY DATE SA I PERMIT NUMBER INVOICE r " z, / /,P3/