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APPLICATION FOR LIOUIO WASTE°ERMIT <br /> v SAN'JOAQUIN COUNTY PUBL-I :ALTH SERVICES <br /> ENVIRONMENTAL HEALA DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> MON-ARIMAKE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> IGmpi.1.In Tripli"uml <br /> APPLICATION le HEREBY MADE TO THE SAN JOAGUIN COUNTY FOR A PEAMTT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED, TNR!APPLICATION IS MAGE IN COMPLIANCE WITH IAN <br /> JOAWIH COUNTY DEVELOPMENT TITLE.CHAPTER B-T I to TjO/SyA/,N�p�TTHEE NIANOARDN OFFS AAN JOAGURN COUNTY WC HEALTH S,ELR/.V CES.ENVIRONMENTAL HEALTH IMW MN. <br /> JOB ADDREBB/OR AP•Nf�/ LOT&2F�j­'14r'l— <br /> CONTRACTOR- IC-I D. AbURE88 G' U' LIC/Y ZZ PHONE �J <br /> SUB CONTRACTOR AOORESS LIC• PADRE <br /> ,M TYPE OF STORK WOKS, NEW INSTALLATION RFPAIW"UT1ON ❑ D-ThuCNON❑ <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AV LASLE WITHIN 2DO FEET OF BUIDING.I PBIC TES71.1 I I IPOW MIRY <br /> APBrN.n <br /> INSTALLATION WILL{BrVE- RESIDENCE�P CDMMEHCIAL❑ OTHER❑ <br /> NUNISR OF LIVINO U IT8:JL MIJNIFN OF IEDNOOMe: -3 "U"m OF EMPLOYEE.' <br /> ER OF SDR TOA DEPTH OF 3 CE —'.UVMP{11Fs-WL CHARACTER WATER TABLE DEPTH �� ' <br /> SPDC TAj11U011fASE TRA► ❑TYIEJMFO Pl ! .LY FILL CAPACITY S �ClLxll NO.COMPARTMENTS L� ' <br /> 7MENT RAM❑ DISTANCE TO MEANEST: WELL rVUNOATION�(^ PROPERTY LINE J <br /> LIFT STATION 11 SIZE TYPE OF PUMP / SAND OIL SEPARATOR RNCLDSEO SYSTEMA_ , <br /> r LGGRNNG Ed �NO.S LENOIH OF LINES 3� /! / •/ECS DISTANCE TO NFAREST:WELL FOLIHDATIOM�_PHOrE N>1'LME ]Cl <br /> FILTER{EP ❑WROTH LENGTH DEPTH DISTANCE TO NFAAEST:WELL FOUNDATION PROPERTY LINE <br /> MOMDED LLLEyyy�WIDTH LENOTN DEPTH DISTANCE TO NEAREST:WELL J FOUNDATION�/ PROPERTY LINE <br /> SEEPAGERTI FE-TL.OEPTN��I oaf �~ NUMBER DIeTNKE TO NEAREST:WELY_ FOUNOATAN--0 / PROPERTY <br /> LAMPS /!41'-'-'F1r WIDTH LENGTH DFPTLI DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> DISPOSAL PONDS 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LWE <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE Wu LL Of DONE HL ACCORDANCE WITH BAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RILES <br /> AND ROVLATgNN OF TETE JOA WING OMEOWNENORLOCENIEOAD SHINATURE CERTIFIES THE FOLLOWNIG:'LCERTIFY THAT INTHLPNOPwLANCE OF THE WOEB(FORWNICH <br /> THE PERMIT S ISSUED,1 TEM NEP SUCH A MANNER ■TO COME NSJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFDFPHA.' OF <br /> HIRNG OR <br /> eu87X— <br /> SIG AT RFI FOLLD O:'I CERTIFY THAI 1 HE PE RMANCE OF THE WORK FOR WHICH THIN RRMIT II ISSUED,I SHALL.EMPLOY PERBDNB SUBJECT TO <br /> ++' WON TIDN C NAA.' U.T ALL]{ URN IN ADVANCE FOR AFI.NEOLLSRPPED 1 BK TIONN, COMPETE pIMWN10 BROW. <br /> ELAIiRLE: /JYv- __DATE: v/ <br /> ROT PLAN mMW TO{CRASS ICAIE <br /> NAMES OF STRE OR ROADS H ST TO DR SOUNDING THE PROPERTY. f.LOCATION OF HOUSE SEWAGE DISPDEAL SYSTEM OR PROPOSED <br /> Z. OUTLINE OF THE PRORTWI <br /> PEY, TH DIM MONS AND NORTH DIRECTION. EKPANMN OF NEWAGE DISPOSAL SYSTEM& <br /> 3.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, E.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> HI <br /> CLuDINO COVERED AREAS SUCH AS PATFOIL DRVEWAYE,AND WALKS- THE PROPERTY OR ADJOINING PIDIERTY. <br /> 7, <br /> Ab <br /> YEA <br /> r _ <br /> 9 199 <br /> - I'LL�i' - tlfvi tI ITV <br /> IL.t� <br /> UfF,L.ILVI "'A' "Er.' 7Pi❑IV451(�;, - <br /> FOR DEPARTMENT USE ONLY <br /> A• APPLICATION ACCEPTED BY DATE, JrtlA: <br /> TANK,PIT OR SUMP INOPFCTm14SY ATE ! ! FINAL INSPECTION BY <br /> ADOtTlONAL COMMENTS, <br /> ACCOUNRNO ONLY: AmI FACE <br /> PE CObE FEE INFO AMOUNT NFNn ITER C1 PCIS" IRECETVED EY DATE NPI f PFRAINT NUYSEI INVOICE E <br /> Pub.Heats Sere--EnvIre 174(3106) <br />