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, APPLICATION FOR LIQUID WAR" 'ERMIT <br /> `.� SAN-JOAOUIN COUNTY PUBLIC HE.v.L SERVICES <br /> `�- ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388,304 EAST WEBER AVENUE,STOCKTON, CA 95201388 <br /> {2091 4BO-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICBmplatE ID Tt;plk.t■I <br /> APPLICATION IS HEREBY MAOE TO THE SAN JOAQUIN COUNTY FOR A PERMfT TO CONSTRUCT ANIVDR INSTALL THE WORK DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WETH BAN <br /> JOAQVIN COUNTY DEVELOPMENT TIt LE,CHAPTER 9-1 110.3 AND THE <br /> STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH 8 RVICEB,ENVIRONMENTA}HEALTH DIVISION, <br /> JOB ADDAEGS109 APNF - - L V 1/ ���,-/ CITY /f LOT 6i2E� <br /> OWNER'S NAME ADDRESS 9!1 r [�(/Sjf 7 JQ�J PHONE <br /> CONTRACTOK It ADDRESS LICs PHONE <br /> SUB CONTRACTOR 7 <br /> .,1 <br /> TYPE OF SEPTIC WDRK: NEW INSTALLATION❑ KUMMADDITION ❑ DEBTRUCTLON❑ <br /> IND SEPTIC SYSTEM PERJAITTED IF PUBLIC SEWER IB AVAILABLE NRTIAN 200 FEET OF BUILDIND.I PFlLC T1.1 I I-W MANY <br /> AFWIa1- ' <br /> INSTALLATION WILL B6IYE: RESIDENCE g COMMERCIAL❑ OTHER Q TF1 <br /> NUMBER OF ONNG UNITS:_XUMBM O BEDKOOMS: MUMB91 OF BrIPLDY <br /> CHARACTER OF SOIL TO A DEPTH OF 7 FEET; SUMP IL CHARACT M WATER TABLE DEPTH <br /> SEPTIC TANKJGREASE TRAP ©TYPE/MFIT CAPACfTY <br /> NO,COMPARTMENTS� <br /> PILO TKFATAIENT PLA11--N--�TI ❑ d4TANCE ED NEAREST- WELL FOUNDATION PAGFERTY LIHE , r ( <br /> LIFT STATION 1__I 611F TYPE OF PUMP BAND OIL SEPARATOR IENCLOSED OVOTEM1 /A/ <br /> LEACHING UNE NO A LENGTH OF LINES_�J J I"/Z DISTANCE TO NEAREST:WELL1CyO FOUNDA71ON�L_AIp PERTY UNE L�- <br /> FILTER BEL ❑WIUTH LENGTH DEPTH DISTANCE TO NEAREST:WEU FOUNDATION PROPERTY UNF <br /> MOUNDED U WROTH LENGTH DEPTH DISTANCE TO HEAREBT:WELLFOUNDATION PROPERTY LINE_,__ <br /> SFEPAGE MTE DEPTH wZE, �T NUMSER 3� DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY WJE 5 <br /> B71A►S L WIDTH LENGTH DEPTH DISTANCE TO NEAREST;WELL FOUNDATION P'ROP4RTY LINE <br /> DISPOSAL PONDS Q WIDTH LENGTH DEPTH DISTANCE TO NEARE:6T:WELL FOUNDATION PRDPERTY UIJE <br /> 5 <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCAT40M AND THAT THE WOPK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY OPSNNANCEB AND STATE LAW@.AND RULES <br /> AND REGULATION:OF THE SAN JOAOUIN COUHTY.HOME OWNER OR LICENSFO AGENT'B SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT IN THE PERFORMANCE OF THE WUW FOR WHLCFI <br /> THIS PERMIT IS 166UEO.I SHALL NUT EMPLOY ANY PERSON 4N SO..A MANNER AS TO BECOME..I CT TO—F-- N'.COMPENSATION LAW.OF CALIFOIWIA_- CONTRACTOR'S HIRING OR <br /> ....CONTRACTING SIONAT USE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOR(POR WMSCH THIS PERMIT IS ISSUED.I @HALL EMPLOY PERSONS SUBJECT TO <br /> WOWMAN's COMPENSATIOH LAWS OF CALIFORNIA_' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REOLBRED INEPECTLONB. COMPLETE DRAW GG BELOW. <br /> SIGNED% <br /> TITLE: PATE <br /> PLOT RAN IDAAW TO SCALE}SCALE 'to j <br /> 1 HARES OF STREETS OR JKIAO6 NEAREST TO pR BOUNDING THE PILOPRTY_ 4, LOCATIUN OF HOUSE BFWA13E DISPOSAL SYSTEM OR PROPOSED !� <br /> 2, OUT UNE Of THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DIEPDSAL SYSTEMS. <br /> 3. DIMENWONEU OUTLINES AND LOCATION Of ALL EXISTWO AND PROPGBED STRUCTUAE., S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDAFD EIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DJYVEWAYR.AND WALK.. THE PROPERTY OR ADJOINING PNOPTRTY, 1 1 <br /> r <br /> 61 <br /> FOR DE►ARTML'JT USE ONLY / <br /> APPLICATION ACCEPTED BY OATS: ts <br /> TAW,PIT OR SUMP INSPECTION 9Y DATE ! 1 FINAL INSPECJION BY OATF I� l 1 <br /> ADDITIONAL COMMENTS' + `— <br /> h.w ACRO UNTIMD DNLY: I AID' FAC' <br /> PE CODE FEE INFO AMOUNT REMITTED CHECK/JCASH RECEIVED BY DATE SIL I PERMIT NLINNEIL INVOICE, <br /> t L- CI <br /> '� J <br />