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APPLICATION FOR LIQUID WASTE PERMIT �, n <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)4684420 <br /> NON-REFUNDABLE PERMIT EXPIRES f YEAR FROM DATE ISSUED <br /> IGwPI/t/IN Tro"ItS) <br /> APPLICATION IS HERESY MADE TO THE YAW JOAOUIN COUNTY FOR A PERNR TO CONSTRICT ANWOR INSTALL THE WOR(DESCRIBED.THIS APPLICATION HI MADE IN COMPLIANCE VAIN SAN <br /> JOAOIM COUNTY DEVELOPMENT TITTLE.CHARTS)1�T 110.3 AND THE STANDARDS OF SMR JOAQUIN COUNTY rusuc HEALTH SEINICE/.ENVWMJEMAL HEALTH pMMON. <br /> pR, CITY IC G -T t"1 LOT SIZE k`I'C�C� <br /> JOB ADDRESY/OR APNI 51at, G 1 n j iAAL�,.G <br /> �]T.yfZSLa •'Ptf.l K ,:DOf1E88 PRIONE <br /> owrmL•/NAME Cr1J'�QAI, <br /> $! f' A riAVI;L:7CtJ ADDREBR 21t E. MR�IX l AtvG Lxf72 '1� fHoxE R <br /> ' coNrnwcroR LC1C 1 <br /> L ' n cF�•�15 MZt.D4•I!f� L.PLNc LTCB" •I 1 �� � ..•�"E �13i-c �t <br /> sus CONTRACTOR`^A•,L�L,.�f,Gp •(y ,t'-- <br /> Y�� ADOK66 <br /> MSW N-ALI.AMN TEPAnVADDITIOX 13DMTRUCTIOM❑ <br /> TYPE OF S�TIC WORK: fOLPTBTNI I I/ADW WARY <br /> IND SEPTIC SYSTEM PERMITTED K PUBLIC SEWER IS AVAILAOLE WITHIN 700 FEET OF BUILDING-) gyp,1 <br /> INSTALLATION WILL SERVE, RESIDENCE Il COMMERCIAL❑ OTHER❑ <br /> wimmoR Of WINO Ways:_I NUMS91 Of[FDR� @UM <br /> O(DMs:—NUMSSim Of DAPLOYE[s: <br /> SOIL To A DEP .� <br /> CHARACTER OF DEPTH OF!FEET: (✓L A L PRP SOIL CHARACTER �P- 17 WATER TABLE DEPTH `1 , <br /> a VL N NO.COMPARTMENTS 'AS <br /> /DTC TANIVOR[ASE TRAP pRTVIfAAIw toA•t`Q�'•Tlr) ��L cAPALYTY�1Pc" I J <br /> /4OI FOUNOATKIN S pROPERTV LINE - \` <br /> WADTRGTMEM PLANT[I DISTANCE TO X[ARPST: WELL <br /> UFT RATION❑ SUE TYPE OF RMP SAND OIL SEPARATOR IENCLOSED SYSTEM)� A <br /> G1: DISTANCE TO NEARER:LVEll ,ACICY FOVNOATION )CI PROPERTY LAZE <br /> ([ACHING LINE ® NO.s LENGTH OF LINES 7' FOUNDATIONPfiDF'ERTY UNE m` <br /> RLTOR Sm ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL \\ <br /> pEPTN DISTANCE TO NEARER:WELL FOUNDATION qq PROPERTY LINE <br /> MOUNDED ❑W1OTH LENGTH 77 /LIO 7 POLADATION UC i FROPFTITY lAE 7 , <br /> SUVA=RT/ ©DEPTH,_[IZE.�J SER 3 DISTANCE TO NEMER:WELL � . <br /> sIMPs ElWROTH W4M DETTH DISTANCE TO NEARER:WEAL <br /> FOUNDATION PROPERTY UNE <br /> DISPOSAL TOMOS ❑VVDTN IF7LOTH OfPfH <br /> DISTANCE TO NEARER:WELL FOUIDATION PROPERTY LNE J <br /> 1 MEAEBV CEA7>FY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOW WALL BE DONE N ACCORDANCE%MTI SAN JOAOUN COUNTY pRpWANCES AND RATE LAWS,AND RUSES -� <br /> I HEESYC TIGN/OFTHE SAN JOAOVIN COWITY.NOMEOWNETIORUCENSED AG -&GIONATURE CERf1FE/THEFOILAWYNG:9CE7RIFYTIIATNTNEFFRFO1rtAANLE OF THEWORITOw000n r1. <br /> THIS PERMIT b ISSUED 1 MALL NOT EMI ANY PERSON N SUCH A MAMIER A/TO BECOME SUFIECT TO WWPLMAMB COMPENSATION(Jaw Of CALTFOI/aA.•CONTERSON IY SUBJECT <br /> \ <br /> WORKMAN'SW&COM�COMMPNYAT CER Of CMHE FOLLOWING! <br /> -1 C THAT'N TN`PoWo E TAN MWT CML 3s/IDLY N ADVANCE►0R ALL R[d#LID[MPBC/T�IOMB.COMPLETE DRAWING offWy 04ANC OF THE WOW FOR WHICH THIS FoWff to ISSUED'I SNALL OBEIDW. QCT TO. <br /> -CI,,�`; �J �+�y^(' TrrLE• ('t'?�{Zf�'T�F DATE: C7 L[1 <br /> SIGNED X <br /> PLOT PLAN IDRAW TO SCALE SCALE •1O <br /> 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. EXPANSION OF SEWAGE DISPOSAL"VMS' <br /> 7.OUTLINE OF THE PROPERTTY.WITH DIMENSIONS AND NORTH DIRECTION. S.LOCATION OF WELLS WITHIN RADARS Of ONE HUNDRED FNTY FT.ON <br /> J.gMENS10HED OUTLINES AND LOCATION OF RV <br /> ALL EXISTN6 AND PROPOSED gTC7URES, TILE��y OR ADJOABMG PRIOP[RTY. <br /> NCLVdNO COVERED MEAS INCH AS PATIOS,pl/VEWAVB.AND WMXS. J _ <br /> AAAA.. AAAA. 7�G• <br /> .. AAAA AAAA <br /> . .. <br /> om <br /> - ..... .. :AAAA..... -._. <br /> t! <br /> L V W <br /> (tW 'A}71 M FEN .:.......w <br /> K <br /> .., <br /> AAAA . <br /> AAAA <br /> �--Z-. ...... <br /> r............. . <br /> APR 24 X998. .... <br /> '. . <br /> . <br /> .. ..... <br /> PU <br /> AAAA.. <br /> E-WRIDNME T L E CA l H <br /> :.. AAAA.. ..:. <br /> . .. .. '. ,DISI 1 <br /> ' ..,..... .... >.... AAAA.. _.. _. <br /> 149 <br /> °r <br /> FOR DEPARTMENT U/[ONLY <br /> AREA: <br /> DATE: <br /> APPLICATION ACCEPTED BY <br /> Ft�INAL INSPECTION BY DATE <br /> p INSPECTION BV DATE <br /> ADdT NACCOMMENTB: "'-�L L�rV�1 �c � �•2' �7• <br /> ACCOUETNp ONLY: MDI FACS <br /> PE CODE FR mra AMOUNT IIMm ITCIB ACASH RCC6V®/Y GATE <br /> M I P9FST XUSS6! SRWOID[/ <br /> 1J <br /> Pub.Health Serv.-EfMTD.174(3196) <br />