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' TIDE) SIGIED3 / DATE, ' 4 LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED EXPANSION OF SEWAGE DISPOSAL SYSTEMS. B. LOCATION OF WELLS WITHIN RADIUS Of ONE HUNDRED FIFTY PT, ON THE PROPERTY OR ADJOINING PROPERTY_ PLOT PLAN [DRAW 70 SCALE SCALE 1, NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. OUTLINE OF THE PROPERTY, WITH DIMENSIONS AND NORTH DIRECTioN. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING *NO EROPOSELI STRUCTURES. INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYs. AND WALKS. " . s',VA • P4 • 41.047 , • ..... 67•17 • • • stp S./44 119Sti ..V147)4CJ:611•17,6,-444.1(1t4.!',:let..64,;t- E.441V'efs: .... : • —7 2rl'eA—,e 7e AREA: T, ICATION ACCEPTED BY R SUMP INSPECTION BY IONAL COMMENTS- DATE: DATE ,47,g, ?MAL INSPECTION 8 APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388,304 EAST WEBER AVENUE, STOCKTON, CA 95201-988 12091 4503420 NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUEO ISaomplois In Trlidisate4 APPLICATK)N IN -REEDY MADE TO THE SAN JOAOUPN COUNTY FOR A PERMIT TO comonucT mcortm iNsTAu. THE WORK DEscRIDED, THIN APPLICATION IS MADE IN COMPLIANCE VEEN SAN JOAOUEN COUNry DEVELOPMENT IDLE, CHAPTER 0-1 110.3 AND THE sTANDARDS OF SAN JEHOUIN COUNTY pUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISPON. JOS ADDRESS/OR CITY LOT sreg; OWNER'S 4.4 NAISE7545 ) r C. ‘ /../z ADDRESS PROW 3,6-C1,p/P/4 AIDIVESS /C, Ye.? - SUB CONTRACTOR ADDREsti VC, PHONE Page TESTNI I 1140W MANY ILINSTALLATION WILL SERvE RESIDENCE ta COMPAEFIcIAL OTHER 0 Nommig OF uvitio UNITE II NUMBER OF BEDROOMS. NUNES! Of EMPLOYEES) 1\ Appits)/Mon CHARACTER OF SOON TO A DEPTH OF 3 FECI)__CAOJ PITRIUMP SOIL CHARACTER) WATER TAME DEPTH SEPTIC TANIVORWAIII TRAP 0 TYPERATG N. ; ati n‘ CAPACITY j:•,2'.1C-• NO. COSEPARTMENTS PEG TREATMENT PLANT 0 0111TMICE TO NEMEPAT• WELL FOUNDATION rnowERTy LINE UST STATION El SIZE TYPE OF 1-DEAP SAND OIL SEPARATOR ENCLOSED SYSTEM LUCIAN* UNE till NO • LENGTH OF LINES r.,,/ . '54 ' ' DISTANCE TO NEAREST: WELL ./E,L.". ' _ FOUNDATION 30 PROPERTY LINE FILTER BED 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST. WELL FOUNDATION PROPERTY UNE MOUNDED 0 WIDTH LENGTH DEPTH DISTANCE To NEAREST: WELL FOLNIOATION PROPERTY UNE sEEPAGIE PRE 121 DEPTH 9S." NEE 1L., -' NUMSER ; DISTANCE TO NEAREST) WELL 7re, •. FOUNDATION 74- PROPERTY UNE _:...i.." . —.... RUMPS 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST) WELL FOUNDATION PROPERTY L/NE B DISPOSAL PONDS 0 WIMP LENGTH DWTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY IRE 71Z 1---- FOR DEPARTMENT LISS ONLY ACcouNnTia ONLY: AIDA FACE _ _ 00 Pi CODE FEE INFO AMOUNT REMITTED CHEC Al NEC ST SR I NEWRY NUIVRER INVOICES (5O zf"() 4102 •5- - DA/ ci 3/97 2_3 S-39 1A-1330 _ CONTRACTOR 27AT,O C ueo 445-Y/w1S--- TYPE of SEPTIC WORK) NEW INSTALLATioN 0 REPAIRMODITION IND SEPTIC SYSTEM PERMITTED IF PUBUC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) DESTRIACTioN 0 NETEBy CERTIFY THAT I HALE PREPARED THIS ANIMATION AND THAT THE WOW. WILL BE DONE IN ACCOFOANCE VRTH SAN JOAQUIN COUNTY ORVINNECES AND STATE LAWS, AND RULES NEC PECULATION* OF THE SAN .113AOUIN Camay. HOME OWNER OR LICENSED AGENT'S SIONATEJM CERTIFIES TIE FOLLOWING: l CERTIFY THAT IN THE PETIFORMANCE Of TNEWORK FON wkachl THIS MAHN' MINIUM), I SHALL NOT EMPLOy ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WON:MAPCO COMPENSATION LAWS OF CAUPorsElA.- COMPACTOR'S HIRING OR SUE-CONTRACTING SIGNATURE CERTINES THE II OLLOWWFO: I CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT 70 WORKMAN'S COMPENSATION LAWS OF CALIFORNIA. THE APPUCANT MUST ClUI. 24 moms IN ADVANCE FOR ALL MEOWED INSPECTIONS. COMPLETE DRAVANO BELOW.