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APPLICATION FOR UO.U10 WASTF PERMIT <br /> SAN JOAQUIN COUNTY PUBLI :ALTH SERVICES �� Q <br /> ENVIRONMENTAL HEALT-K DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NON-REFUNDABLE PERMIT EIIPINE6 I YEAR FROM DATE ISSUED <br /> -� (Camplall In TrIplicalal <br /> APP ICA7IDN le HEREBY MADE TD THE SAN JOApUIN COUNTY FOR A PERMIT 70 CONSTRUCT ANDAR INSTALL 704E WORK DESCRIBED.THIS APPJCATIOPI 1E MADE IN COMPLIANCE WITH SAN <br /> JOADUM COUNTY DEVELOPMENT <br /> ,1lTITLE,CHAPTER 110 3MD� �DAROB OF SAFJOAOAN COUNTY PUBLIC CHEALTH SERVICES,ENVIRDMUEMAE HEALTH dN_S_q N <br /> � ) LO, <br /> T BFLf <br /> JOB ADDREBIAR AFYI 'V 7 <br /> ,� OWNER'E NAME N -C�'-'Y G ADDRESS F PHONE <br /> COMMC70R ADDRESS [^ I me PHONE l/J� <br /> SUB CONTMCTOF�/ "-�'/�-V ADDRESS IZ I C �Q <br /> TYPE OF SEPTIC WORK: NEW 1Na7ALLADD RERAIRIAoulloN❑ pFAIRUCTIOX❑ <br /> INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS VAILABLE WITTEIN ZOO FEET OF BUILDING_I PeRC TES1I.1 L I HOW MMMY <br /> NFKw•Se� <br /> INSTALEA TION WILL SERVE: RISIOENCE"o COMMERCIAL❑ Q7HER❑ <br /> IV <br /> NUMEOR OF LING UNITS: S <br /> _/ MIMEM OF Sn*oam ' NIMIBOR OP LLMPLOVESIL <br /> w 'I'll" <br /> ABLE DEPT <br /> F^" PITJRUMPSOILCIIARACTE <br /> T ATOPDPTHOF❑]TVPEWf CAPACH ' <br /> ND.COMPAMTMENTI <br /> TMENT PLANT❑ DISTANCE TO NEAREST: WELL:J� FOUNDATION I�• FROPFRTY LINE�� <br /> LFT STATION❑ UZE TYPE or PUMP SI <br /> n �-^ANND OIL SEPARATOR IENCLOSEO SYSTEMI , <br /> LLAOIPNO LINE D.•IENOTH OF UNE��(- IIFI%'-le FLY .STANCETO NEAAEET:1NEL.L no FOUINDATNIN h PRI)MRTYUNE J <br /> r FILTER DEO ❑WIDTN LENOTH DEPTH DISTANCE TO NEAREST:VVUI MUNDATAN PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH d1TANcE TO NEAREST:WELL }� NbFOUNDATON PROPERTY UNE <br /> SEEPAaE NTA PTH�� EN <br /> r SIZE NUMBER � DISTANCE TO NEAREST:WEU/' V_POUOATH ' >"PNOI'ERTV lWE ---,7, <br /> SUMPS !!!❑F�YWIDTH LENOTH DEPTH DISTANCE TO HfAAEST:WELL FOUNDATION NLDPRTY LINE <br /> ,r DISPOSAL PONDS 1.J TIDTH LENGTH DEPTH dBTPNCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TMl APPLICATION AND THAT THE WORK WILL Of DONE IN AE CORDANCE NRTH BAN JOADUIN COUNTY ORDINANCES AND STATE LAWS,AND RLMkz <br /> AND REGULATKMO OF THE BAN JDADL1IN COUNTY.NOME OWNER OR LJCENMO AGENT'S SIGNATURE CERTFIES THE FOLLDWINO:-1 CERTIFY THAT SI THE FEPFORMANCE OF THE MARK FOR WHICH <br /> PERMIT N BSUED,1 SMALL NOT EMPL ANY PERSON IN SICU A MANNER AS TO BECOME SUBJECT TO WON(MAN'E COMPENSATION LAWS Of CALFOIFIIA-- CONTRACTOR'S MM4 OR <br /> BUB INp S CERTIFIES T E FOLLONRNG;'1 CERTIFY THAT IN THE PERFORMANCE DF THE WOW FOR WHICH THIS PERMIT 12 ISSUED,I WLALL EMPLOY PERSONS SUBJECT TO <br /> WDRKM I' M LAWS OF C IWIA.- THE T MUST CALL EA HOURS IN ADVANCE LL REOIIRLD INSPECTIONS. COMPLETE DRAWING BELOW. <br /> +.r ZONED TITLE. 1 DATE: S <br /> PLOT PLM)AIMW TO SCALE)SCALE <br /> 1.NAMEB OP STREET■OR ROADS NEAREST TO OR BOVNDBM THE PIDPOITY. Ie4.LOCATwN OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> r Z.OUTLINE DF THE PLOPERTY,WITH--ENSIGN■ANO NORTH DIRECTION. T]TPANSION OF SEWAGE dSPOIAL SYSTEIAS. <br /> ]_ DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES. S. <br /> LILOCATION OF WEUS WRHIM RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> WCLVDING COVERED AREAS SUCH AS PATIOS.DNVFWAYB,AND WALKS. THE PROPERTY OR ADJOINWO POPERY. <br /> . .. �-LL- <br /> t <br /> ,.� tN�tP�^1'�ENTkt,NFA <br /> Pti. i <br /> -s APRICATION ACCEPTED BY VV �L V c� •gypv` �`+++'][� APTMFTIT USE ONLY DATE: AREA: <br /> TANK,PIT OR SUMP SISPCTIOU BY VV D��A`TE 1 I FmAI WEIPECIID ` GATE� ( SLI <br /> ADDITIONAL COMMENTS: <br /> ACCOLMRXO ON- AID/ EAC/ <br /> PE CODE FEE INFO AMOUNT ROMIITFD CIIECPJ ASH RFCOVFD SY DATE M I PERMIT NUMBER IMYOIGE f <br /> Pub.Health Sere.-Fnwro.174(3196) <br /> 4 <br />