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APPLICATION FOR LIOUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,X46 R.SAN JOAQUIN ST.STOCKTON,CA 95201.03BI <br /> =1 468.3420 <br /> MOR•REFUNDA/LE MMMIT 2"IREf 1 YEAR FROII DATE gfU�p <br /> w KSMrMm M TibUmmI <br /> APRICATLON R HERESY MAGE TO THE SAN JOACUIN COUNTY FOR A RRMIT TO CONSTRICT ANOCR INSTALL THE WORK pESCIMm.TRB APPLJCAT10N R MAO[IN COMPl1ANCE INTI/SN <br /> JOADIAI C %TY DEwWMMEM/MTEE,CNI&M TER S-1 110.1 AND THE STANDA M OF SAN JOAQUIN COUNTY PURUL HEALTH SERVICES,ENVBONuOffAL HEALTH OMSION. ��� t <br /> JOE ADDIEBBAIR//A��EN;�'7S ���'�`-J 41 i- (,G/ .' a .•�CITYY �1'P7S�I�o LOT <br /> y1vz2—�L/i <br /> OWIEH'S NNE Clw 6tf'ey, it;SeS AOOHESH D / �1C�Cy� RiDHE k /�170� <br /> CONTRLACTOq JIl1 77To�� �C�'D- _•.__,_ADDIEBBlx�!�/'��.'/!�-. LIC.���5` PHONE�''� <br /> IR CONTTIACTOR ADa1Ea ucP FIAT <br /> TYPE OFB/I10 WOR(: NEW WSTALLLATION NE WRIADMTIOM❑ INRTROTON❑ <br /> IND SEPTIC SYST13A PE/EITTE91C PUBLIC WWER IS AVAILABLE WITHIN 700 FEET OF BUILDING-) P[11C TESTNI l I NCM MANY <br /> AFd�ton S_ <br /> NSTALLAMON WILL SmNK: PESIUERCEY COMMERCIAL❑ OT/ER❑ <br /> MUMEMI OF LMNO URTS: I�NIA`>•O df Kromei NRSL<!O OF MKOTO: <br /> F 80l TO A DEPTH OF?FEE' ^� �Aftle E+I�P BD4 CHAAACTEII: WATER TABLE DEPTT _ <br /> StPfIC T Ti1/V ❑TYPEAiF9 l'CT'BL AE fCt`•I�L CAPACITY D •J. NO.COEPA1fThYORS�_ <br /> 7ANBrT RJIRIT❑ DISTANCE TO NSARNH: WEl1 SO tFOUNDATION +Z- TNDPfl1EY LME SD <br /> LIFT STATION❑�p&a K TYOF RUMP.J�� SAND OIL SEPARATOR ENCLOSED SYSTEM .�N <br /> LEACEw1 111E 7 NO.S LENDTH OF UNES 3 Yy /.'/j C S ORTANCE TO NEAREST: L WELL FOUNDATION PROPERTY LIE <br /> RTO BED ❑WIDTH IENOTN DEPTH DISTANCE TO DEAREST:NETT FOUI�TION RIONf1RTY LINE <br /> MOUND= ❑WIDTH LENGTH OFPTH DISTANCE TO NEAREST:HELLFOLMOATION PPIOPPTTv LINE <br /> T <br /> LAOS IRS 8 DEvrH _BI7E �NUMBER DISTRACT TO NEAPEST:WELL/,SD POINDATION O i`PIOPfRTV 111E y� <br /> SU►rE ❑WIDTH LENGTH___DEPTH DISTANCE TO NEAREST:WELL..PDUMDATIONPROPERTY UN! <br /> DISPOML PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO PEAREST:WELL._FOUNDATION PRDPOTTY LINE <br /> I NREDY Ctl1TlY THAT I HAVE PREPARED THIS APPLICATION AND TRAY THE WOR WILL BE DONE W ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RILES i n <br /> ANDIEAUULTONB OFTNE SAN JOAOUIN COUNTY.HOVE OV/NEA ORUCENBW AOFJT'B SIONATUFE CERTIFIES THE RDLLOVIIfIO:'1 CERT1YTRUT NTNEPETtl'OIYANCEOP 14 <br /> TING <br /> M `V <br /> S PEIT R LL ISSUED,I SNJ NOT EMPLOY ANY PERSON IN SUCH A ER AS TO BECOME S,LIECT TO WB TIO <br /> ORKMANCOMPENSATION LAWS OF CALIFDINA.'CONTRACTOR'S HA/O DR N <br /> 6USC0M GNA RE CERTIFIES THE WINO:'I CEMiFY THA THE PDWORMANCE OFTHE NOR FOR WHICH TWO PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO <br /> AWS fORH1A' APRLOANT M ALL 7M HOW IN ADVANOE FOR ALL REDNI®IRSPDGTLOHSCOMPLETE RAINING SEUDW. <br /> % TRIF: 1� (I-3 /J �V <br /> GATE: <br /> PLOT PUN IDIAW TO SC.SCALE m <br /> 1.NAMES OF STREETS OR RROAD8 NEAREST TO OR BOUNDING THE PROPERTY. M.LOCATION OF MOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED � <br /> 7.DUTLNE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EKPANSION OF SEWAGE DISPOSAL SYST[A IL <br /> 3.DIMENSIONED OUTUMS AND LOCATION OF ALL Mi TING AND PROPOSED STRUCTUR`.B, S.LOCATION OF NEW WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> HRC NEAR SUCH AS PATIOS.DRIVEWAYS,AND WALKS. THE PNOPERTY OR ADJO0mG PROPERTY. <br /> .. AAAA .. ............ <br /> - .. ... .. AAAA.. <br /> . .5 ... <br /> ' _ � <br /> n <br /> AAAA. . . . . . <br /> ... .._........................... — .. AAAA... ........ <br /> D� ...................... ..... . ... <br /> .. AAAA.. <br /> AAAA <br /> ..... ....... . ...... ....... ........ <br /> 1� <br /> 7� ; ...... ... _ . <br /> AAAA ._AAAA. <br /> .;AAAA <br /> :... <br /> . ............i.........i <br /> : . . :AAAA ..... <br /> . ...;.. .. . ., AAAA <br /> • ..• <br /> 9199 <br /> .................. .. ............................ AAAA _ <br /> . . .. ...:. <br /> .. :. AAAA.. <br /> S. EALTH SEH iU-i- <br /> PLiBLIC H , <br /> .>..' ..................... .... .................................,..... ...... <br /> 1.:LVtI IAQN MEt11S AJ,.titi: <br /> ................. <br /> I FOR OSPMRTML7EF U041 ONLY O <br /> APPLICATION ACCEPTED BY C • DATE: <br /> TALK.PIT OR SUMP INSPIC"N'8/11 1 ± ERIK IIRILCTION BY <br /> ADDITIONALCOMMENT/: W-Cil ,rIF•Tj�' "' T'�1 <br /> Gcx.c� -f>ti tri !•� — //o -f eA-'Gl! >� � . — /so'�- <br /> ACCOURRINE ONLY: ADM FA1CF <br /> P4 COOK FRF 1110 AMOUNT AIMTTED A:aN RSCRVEO BY RATS M/1'11AMIT MMIMSII INVOICE F <br /> L (J J V� <br /> S�bbo'1g5� <br />