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APPLICATION FOR LIOUIO WASTE PERMIT A I')U • SAS AOUIN COUNTY PUBLIC HEALTH SE "ES +' ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 ( � (209) 468-3420 T, NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED D (Complete In TrlplieRl•) At"ICATION IP 1,FRFRY MADE TO TNM PAN JOAOUIN COUNTY rOR A PERMIT TO CONRTOUCT A"MOn fW"ALL TIIE WOIR OFRCRINFO. TUBS AT A COMMI E Wlt 11 RAN JOAOUIN COUNTY DEVELOPMENT TFTLF.C"APTEn 9-11 10.3 ANO TIIE GTANOAnDS OF RAN JOAMON C/OIONTY PUGUC HEALTH @EFt"CES,ENVInowtm AL IIEALTII DIVIGOtI. .IOP Anf)nFnwon APMf —3 r A�L -YaNY AW Qk 73 -2/0—/`/� /�CItY 11/6'01 lot RNr 14c- OWIIFR'P IIAMf.P�.(� � // /1/�W/Z �s�ADORF PP /f�fS �/� C-al-p IYIONF�3 L r_Z r/ CONI nnCTDn C L F�� /N1 J AODnFRP /'Z gS JJ• A/Y7Ee=6 /lop LIC• MIOMF PIIS CONTnACTOn ADOR@G LIC/ MIONF TYrF Or SFrTIC WORK: NEW INSTALLATION ❑ RFTAIR/ADDITION ❑ oratnUCT10N ❑ (N0 ntritc PYRTEM PFnmit-TEG IF PI1nLIC SEWER 18 AVAILABLE WITIItN 200 FEET Or RIJI1_I7NNO.1 TRIC 110411.11 I NOW MANY Z INSTALLATION Wlfl 01"WE: RESIDENCE❑ CoMMEMCIAL ❑ OTIIFn ❑ Nl1MRFn OF LIVING UNITS: NUMBE OF RFIN100M6! NUMPF"OF P APLOYFFS: CIIAnACTFn OF SOIL TO A OFPTN OF 1 FEET! MT/nUMr ROIL CIIARACTFR: WATFn TABLE DFrTII SEPTIC TANKMIFARF. TRAr ❑TYPF/MFO CAPACITY NO.COMPART MFWR Mn TREATMENT►IANC❑ DISTANCE 10 NEAREST: Wrll FOUNDATION MOMITTY IINF IN't STATION❑ S17F TYPE OF MIMI, SAND OIL.SErARATOn fFNCIOSED RYRTFMI I FACIIINO LINE ❑ No.P LFNOTII OF UNFR OIPTANCE TO Nf AnFPT1 writ. FOUNDATION r"nM,MY IINF "tTRf PEO ❑WIOTII I.FNOT11 DF.PTII DISTANCE TO NEARf PT!WFIJ. FOUNDATION MIOPFRTY IINF _ MOUNDED ❑WIDTH LENntll bEPTII DISTANCF TO NFAMOT!writ. FOUNDATION M10PfFOY IINE RFEPAn@ PIT* ❑nmll S17F NUMBER DIRTANCE TO NFARERTt WELL FOUNDATION PmrfnrY IINF RUMPR ❑WIOTII LENGTH OFPTII DISTANCE TO NF.AREPT!WELL FOUNDATION PROPERTY 1111E DISPOSAL POND• ❑WIOTII LENOTII DEPTH DIRTANCE TO NEAREST!WELL FOUNOATON r1%OPEnIY IINF I NfnFBY CEnIIrY THAT I IIAVE PRFPAniv 7I1IG AMYICATION AND TIIAT TIIE WOrSL WILL PF.DONE IN ACCORDANCE W Il SAN JOAOUIN COUNTY OROINANCEP ANO RTATE LAWS,AMD RIR FS AND REGULATIONS OF TIIE GAN JOAOUIN COUNTY.HOME OWNER OR UCENRED AGENT'S GONATIIRE CERTIFIES TIIE FOLLOWINO!'I CERTIFY THAT IN THE PERFORMANCE Or TIIE WOIW fOR WIRCII THIP PERMIT IG ISSUED RIIALL NOT EMPLOY ANY PERSON IN RUC"A MANNER All 10 BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.* CONTTIACTOn-R NIRVtO On PUB CONI DIGITING TUBE CERTIFI IF rOLLOWINO!'I CERTIFY TIIAT IN TIIF PERFORMANCE OF INE wOr•I ron w111C11 TIIl@ F'E11MrT IN ISSUED.1 MIALL FOAM DY Pf.nRONR Rl1P.IfCT TD WOFaCMAN'R COM S TON LAWS rORN1A.' TIIE APPLICANT MUST CALL N 1OURS IN ADVANCE rOR 1ALLLL REOUMFTI INSPECTIONS, COMPLETE DRAWING GROW. PInNEn X �4// TN'LE: V • I DATE: !�M 7-`l OT PLAN IORAW TO RCALEI @CALF /•e le I. NAMES Or PTIIEETR OR"OADG NEMFST TO On ROUNDING TIIE PROPERTY. 4. LOCATION OF HOUSE SEWAOF DISPOSAL SYSTEM On PMPO@En 2. OUTLINE OF TIIE PROPERTY.W/TN DIMEN8ION8 AND NOI TII OInECTION. EXrANBON Of RFWAOE 018P08AL SYSTEMS, 3. DIMFNPIONED OUTLINES AND LOCATION OF ALL EXIRTINO AND PROPOSED STRUCTUnER, S. LOCATION OF WELLS WITHIN RADIUS Or oNF IIIINDnED FIFTY FT.ON INCLUDINO COVERED AREAS 8UCN AS PATIOS,DRIVEWAYS,AND WALK@. THE PROPERTY On ADJOININO PROPERTY. PAnCFG Z « I f2: rVFr � S 11 EEr f Er15 0— rrPz.-frSf lr /'1 i�I►hf Fl. f0Pc'FFsr SitFb , SPR � 01 :O:u f� SNd IUAL/1 1 411 V FV r,U'NMI°HTAI'IIrAIaI\ItI)1.+t!.', CAL L7 _ �t7 �ID c 1 ------ ro'p1n DFPAPt FNT USE ONLY / 1 ^/� A/'11/CAIl01l ACCrrIEn IV , �V•�� l `/�� DAT F:� ( AREA. ' OAT FINAL INRrECTION RV11 DATF I AtM,I1f OR n11MP INSPFCT1011 BV F / / l ADDITIONAL COMMFNTS:_ ry � V" I I �- In - ACCOUNTING ONLY: AID# -- -V1 MCI 1 PE CODE FEE INFO AMOUNT"Mn I TED -CIIEC K/ICASII RECEIVED BY DATE $A I PERMIT NUM11111 INVOICE Pub Ilnnllh Snry -Fnviro. 174(3/9R)