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APPLICATION FOR LIQUID WASTE PERMIT C�G'05d(o <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES— <br /> r%,r,-,'\IED <br /> ENVIRONMENTAL HEALTH DIVISION "j`4 <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 MAR 2 2 1999 <br /> WON-REFUNOARLE PERMIT EXPIRES 1 YEAR FROM DAT€ISSUER ItiUN;v-N!AL HEALTH <br /> ComRIPb t0 TFiMRna) .S <br /> APPLICATION IS HERESY MADE TO THE SAN JOAOUIN COUNTY FOR A PET TO CONSTIIUCT AN=R INSTALL THE WONT(DESCRIBED.THI8 VG9JCA IB IH COMPIINKE WITH SAN <br /> JOAGUM COUNTY DEVELOPMENT TITLES -r <br /> CHAPTER 9-1110.3 AND TTHE'STANOO`R"AOF SAN JOAOVIN COUNTY PUBLIC HEALTH SERVICES,ENNRON1WITAAL�7HEALTH DMg <br /> SN. <br /> JOB ADDFMS=A APNP 1 8 . 0 Q <br /> /V.� Ivo .4� J'1�"c'1 I CfTY R LG�1.y// �/'b-. __.__LOT 872E <br /> Ol WWO NAME c/ C✓!lll.a1H ALXDREss 33Z Petr-EDN !4uel •C4f• r+IOFE .�/Afff/1(7J'Tj!`. <br /> CONTRACTCH VLrlwl fl• LOSS 4G fa A/ ADDHES8 aV d L�S J*�5 1"u •. LICA f:,j21PEOME S�lUIi91-/77V <br /> SUBCONTRACTOR ADORERS _ LIC/ PHONE <br /> TYPE OF SLT'TIC WORK: NEW INSTALLATION❑ ReEyNIDNRDdno OBSTRUCTION❑ <br /> D40 SEPTIC SYSTEM PERMITTED IF PUBLIC SEINER 98 AVAILABLE WRMN 20D FEET OF BUILDING.I FERRO TBSTM I I"MAP <br /> JUPPS^N^n/ <br /> INSTALLATION BILL SIPME: RESIDENCE❑ COMMERCIAL. OTHER❑ <br /> MINER OF LIVING UMTS: NUMBER OF BEDROOMSNUMBER OF BMPL/OYEEl: <br /> CHARACTER Of BOIL TO A DEPTH OF J♦fFf� P !IJM�II CIIARACTEIF.-� AILF DEPTH <br /> BIOTIC TAMKIOIEASE TMP 0 TYFFMFO CAPACITY No.COL/PARRMEMB <br /> PKO TRUUTUMT RANT CI DISTANCS TO MEMEJT: WELL I FOUNDATION PROPERTY LINE <br /> LIFT STATION CI BRE TYPE OF PUMP SAND OIL SEPARATOR DNCLOBED SYSTEMI 76 <br /> LEILCHNG LINE 0 M.A LENGTH OF LINES DISTANCE TO NENEST,w ELL__LSZ�_FOUNDATION PIOPERRY LINE .5 N <br /> FILTER SED ❑WVTH LENGTH DEPTH DISTANCE TO NEMEBTI WELL FOUNDATION PROPERTY LINE <br /> MOMOm ❑WDTH LENGTH DEPTH DISTANCE TO NEAREST:WELD_FOUNDATION PROPERTY UNE <br /> SEEPAGE FRB ❑DWTH SEE NUMBER/ DISTANCE TO NEAREST:WELL�7 FOUNDATION PROPERTY LINE <br /> BLIMPS Am u.ru 1�1 LENGTH DEPTH­1 / DISTANCE TO NEAREST:WELL/ I* NOR TIONP OPMTY LNE <br /> DISPOSAL POFOS i�❑'WDprIt ems^LENOTH OEITHT/ T DISTANCE TO NEAREST:WFL- FOUNDATIONRgPHRY UNE <br /> I HEEBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL K DONE IN ACCORDANCE WITH SAN JOAOUN COUNTY OMMAPKI&AND STATE LAWS,AND RULE" <br /> AND IEGUTATIOHS OF THE SAN JOAOUIN COUNTY,NOME OWNERORLCENSm AGENT'S SIGNATURE CERTIFIES THE fIG LOWN0N'ICUMFYTHAT I/TMEI ERFORMANCE OF THE VMPK FOR WHICH <br /> THIS Pal MIT N ISSUED.I SHALL NOT EMPLOY ANY PERSON O SUCH A MANNER AS TO BECOME SUBJECT TO WOMMANY COMPENSATION LAWS OF CALrOfMA'CONTM.CTOR•S HIWIG OR <br /> SUS-CONTRACTING MONATURF CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PEPFOPAANCE OP THE WORK FOR WHICH THIS PFJW T IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> V40WMW O COMPENSATION LAWS OF CALIFORNIA.-IA.• TIE APPLICANT MUST CALL 34 HOW M ADVANCE FOR ALL REODIFm iMSP'6TIORS.COMPLETE D AVVIO BEDW. �/j� <br /> IBONm% K✓ (`C TTRF: D��'— ( DATE: ? -/ f' <br /> OT PLAN DRAW TO BCAL.[7 SCALE 'Io f <br /> 1.NAMES OF BTFRETB OR ROADS NEARE8T TO OR SOUNDING THE FFIDPERTY, 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PPOPMD <br /> 2.OUTLINE OF TM %M DI <br /> PIOPERTY.WMENSIONS AND NORTH DI ECTION. EXPANSION OF SEWAOE OHAOaAI SYSTnW <br /> 2.DIMENSDHLD OUTLINES AND LOCATION Of ALL EXIBTINO AND PROPOSED STRUCTURES. E.LOCATION OF WELLS WITHIN RADIUS OF ONE HUMPED FIFTY FT.ON <br /> MCLUUMO COVOED ARDS SUCH AS PATIOS.DRIVEWAYS.AND WALICB. THE PROPERTY OR ADJOMMO P"OPEMY. <br /> .... ... ...4, 1�'; ', ... <br /> sp►� <br /> ... .r . <br /> N <br /> 5 >r <br /> .... <br /> q <br /> ....: .... .... <br /> a1h-. 74 <br /> �:YIFif <br /> x►S <br /> S . .. . R:2 31999 <br /> ._ <br /> 4! i <br /> ... .. ENVI ✓t�ES <br /> ..... ?�?NNIf�NfAl.}iEAETfi+'Rif,131EN <br /> giogra <br /> DWARTN"T UBEONLV <br /> r�N.y <br /> �/1APPLICATION ACCEPTED eY /)) + � +-�-� NTE: 'a" JJE'l�TALK.PIT OR U BNBPEC (Vy(h ,D-ATE 1 / FINAL INSPEL`TDN BV DATE <br /> ADDITIONAL COMMENT": —1 P,.P <br /> ACOOUNTMo ONLY: AW PACT <br /> R CODE FMINFO AMOUNT PAWITIM CI MH NBCBVm my <br /> DATE SR U PeART NIMER INVOICES <br /> Ha16 ;-,50 38o <br /> Pub.Health SSrv.•ErL m 174(3,W) <br />