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APPLICATIOlY FOR 1,1010 WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC .LTH SERVICES <br /> ENVIRONMENTAL HEAL)—.01VISION {} <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 Doll <br /> (209)458-3420 <br /> KOTI•REFURDAUtE PERMI EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICFRIp1FtF IS Tliplk-tal <br /> APPLICAIIOIL Ie HEREBY MAGE TO THE BAN JOAWIN COUNTY FOR A PEEUU T TO COMSERUCT AND101 INSTALL THE WORK IXBL WEED. THIS A.AMN le MAPF IN COMPLIANCE WITH AN <br /> JOAOUW COUNTY 11EYELOPMEN�/-TTI�T,LIE,CHAPTER 9-1110.3 AND THE eTANO/A}nG OF SAN JOAOLIIN COUNTY PUBLIC HEALTH JS EE/.R"CEF.ENNAOMMEMAL HEALTH DIVISION. J <br /> JO6 AOCIRESSA%APN/Jf/� 1v�`y1}� A �c^'+Uh' '7 /l�[� Y•Y / / ( C.mn /!7 f"� 7 LOT N2E'^'U <br /> Vq <br /> OWNER'S HAMS 1 Ul'� AOPREee I �C!77 J� C Ln[lI 5 ILCY J PTIONE 3G�-l7n to <br /> CONTRACTOR_ C fa- V !_ '}', t ADDRESS ,A/. SIC(— <br /> IV" <br /> �J IK/ (/.f' 7�^pLbNE <br /> SVB CPMRACTGR R r" ! �.c ADDK56 1 I `• •tcE.L�1,',l `/"Tr LC/ + �F J RIDN{ C/�3 Y3 <br /> _ IV"of SEPTIC WORK: HIM INSIALLA11OX R[lNR/ADMTIOM ❑ PFiiRVC1lDM❑ <br /> IND SEPTIC SYSTEM FERM7I110 IF PUALIC SEWER le AVNLARLE NRTHIN 300 FEET OF BUILOINO.I FSK TE171H[I HOW MANY <br /> A.~—F <br /> INSTALLATION WILL SEILVE: RESIDENCE COMMERCIAL❑ OTHER❑ <br /> NLSASER OF UNND twig: / MUMMER LIF SFARDOMS: L XUMSIR OF EM OYESS', <br /> R PF COIL 70 A Of PTH OFF�3T FETT:All� PrTMU �y]p1-I-L CHA <br /> -+ RACTER:O ^M �i WATER TABLE DEPTH !Gk ' 'L.FJ'TIC TA BASF TRAP IJ 1"!1{MIFO 5LL �-M,�P�` CAPACITY I No COMPARTMENTS <br /> MG TREATMENT RANT❑ DIATANCE TO NEAREST: WELL Q ~ FOUNDATIONS PROPENTY UNE d <br /> LIFT STATION❑ SIZE TYPE OF•7PUMP BAND OIL SEPARATOR(ENCLOSED BYSTFW /0 <br /> J <br /> LEACOSNO LINF NO.►LENGTH Of LINE. "3- L/O 7 "//(C J DISTANCE TO NEAREST:WELL GLl 7 I MUNOATMN ' REOPEREY UNF57 <br /> FILTER FED ❑MOTH LENGTH DEPTH EPSTANCE TO NEAMBT;WELL fOUNDATTON PRIOM11TY UNE <br /> MOUNDED }❑WIOTN LENGTH DEPTH DISTANCE TO NEAREBT:WELL FOUNDATION PROPERTY RINE <br /> SEEPAGE POTS i.i DEPTH _MZ[ PAF NUMBER^DIRANCf 70 NEAHEBT:WELL.Z5 / FOUNDATLON /b / NbPFRN ME S I <br /> at"" !!1❑1---II WROTH LENGTH DEPTH DISTANCE TO NEAREST;VVELLFOUNDATION PRDKRTY UNE <br /> DISPOSAL FONDS L.J WIDTH LENOTH DEFTH DISTANCE TO NEAMOTi WELL FOUNOATRON PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOWL WILL RIE GONE IN ACCORDANCE PORN FML JOAOUIN COUHTY PRDINANCEa MI6 iTATE LAM,AND WILES <br /> AND TLPNSOF THE BAN JOAQUIICOUNTY.HOME OVMIER OR LICENSED ADENT'B SONATUFE CERTIHEa THE FOLLOWING:%CEWrWYTHAT IHTHE RRFORMANCE OF THE WORK FOR WMCH <br /> TINS rERMIT ISSUED,1 NOT EM Dy=-RIBBON S.NCH A MANNER AF TO BECOME SUBJECT TO VVORKMALN't COMPEOSATHM LAWS OF CALIFOFSIA-' CONTRACTOR'B""NO OR <br /> eUa�PNT FIAT CfRTIF1E HE FOLLOWING:'1 CERTIFY THAT IN THE PEUfOFWANCE OF THE WORK FOR WHICH THIS PERMIT Ia WSUE0.i SWIRL EMPLOY <br /> KRSON■SUBJECT TO <br /> SU MAN'S PE /T WF ffOFMIA,' THE AI'TYCANT MUST GAIL 24 HOURS LM ADVANCE FOR ALL RSOLSIED INSKCTIONS, COMPLETE DRA1MNO BELOW. <br /> SIONE <br /> DATE. <br /> X <br /> [ J 1 [ <br /> d <br /> PLOT PLAN DRAW TO SCALER SCALE J <br /> 7.NAMES OF STREETS O ADS NFJLIIEST TO OR..U—THE iROKRTY. Ion.LOCATION OF MORE SEWAGE DISPOSAL SYSTEM OR fYYIPOSEO <br /> 2.OUT WIE OF THE FROKRTY.WETM DIMENSIONS AND NORTH DIMONLOCATION <br /> of aELLB W DISPOSAL SY OF ON. <br /> 3. MMENSONLO OUTl1HES AND LOCATION OF ALL EXISTING AND PILOPOSED S1RIICTUMS, E.LOCATION OF WELLS WITHIN IRAORIa OF ONE HUNDRED FIPTY FT.ON <br /> INCLUONG COVERED AREAS BUCH M PATroS,OWVEWAVS,AND WALKS. THE pRPPERTY OR AIIJOINBlO HOPERfY. <br /> 17��J.2r <br /> G , <br /> u <br /> C i7 <br /> .. .. A F MEILTWEOMLY <br /> f V <br /> HATS. �/', � AREA:�� <br /> APP(-(CATION ACCEPTED BY <br /> (�,ODR SUMP INSP{CTIOII BY <br /> GATE/�121! YFINAL INSPECTION BY uATE ! <br /> ADDITIONAL COMMENTS' <br /> ACCOUNTING ONLY: AION FAGS <br /> K COD{ FEE INFO AMOUNT RRA ITED (CASH TLEGLTVFD ON DATE SRI FewT1T HU(SSR INVOICE f <br /> Pub.Heeflh Serv.-Enwo,174(3196) <br />