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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> NON•REFUNDASLE PERMIT EXPIRES I YEAR FROM DATE I88QED <br /> (Ctwl►IBts In TT*katB) <br /> APPLICATION IS HENNERY MADE TO THE BAN JOAOUNN COUNTY FOR A PEMATT TO CONETRUc r ANONR INSTALL THE woo DESCFWED. THIS APPLICATION b MADE IN COMPLIANCE NRH SAN <br /> JOAOUIM COUN)Y DEVELOPMENT TITLE,CHAPTER 0.11 100..3 AND THE STANDAIIDS OF SAN JOAOURN COUNTY PUSLIC HEALTH SEWICES,FNM IONME7RAL HEALTH WASSON. <br /> JOB ADORESSA'HI A"NP LJCTrY <br /> OWNER'S NAMEC�j ADDRESS ! PHONE_ izla 3 <br /> C014TRACTOM W[�i j b p.1 r&G S:j--.-- 3 ✓S 3 .'Sc -L M r paC11C.!2, <br /> sun CONTRACTOR AN]ORE68 LIC/ !NONE <br /> TYPE OF sSFTIC WORK: NEW INSTALLATION �/� RrLPASUADDITION ❑ DEJNTRIxTI011 ❑ <br /> IND SEPTIC SYSTEM PERMrrrEO IF F'TSUC SEWER 16 AVAILAOLE NTTWM 200 FEET OF SLRDNJO.) FEW TMT G1 1 I MOW MANY <br /> INSTALLATION WILL BIIVt: EL-C-1 MMERCIAL 13 OTHER❑ <br /> NUMBER OF LIVING STS, Nl1Y6L <br /> AFMrMn F_ <br /> 0i BEbROOM/: NUMBER OF EMR.OYM: <br /> CHARACTER Of SOIL TO A DEPTH Of 3 FEET_:-"C I PER TISUMP SOIL CHARACTER: WATTABLE DEPTH <br /> NEFTIC TANKIBUASE TRAP [}TvPmpq CAPACITY 1 NO.COMPARTWNTS <br /> PLG TREATMENT PLANT 13DISTANCE TO WA010T: YYELL 'Z r) . FOUNDATIONPROPERTY LLNE,r <br /> LUT STATION❑ SIZE TYPE Gf PUMP SAND OIL SEPARATOR IENCLOSEO SYSTEM)_ I ^__' / <br /> LEACHING UNE QJN q,s LEMTOF UNEB�.� DISTANCE TO NEAREST:WELL FOL/NOATION —/ -PFIOPEMY UNE <br /> FILTER BLD ❑WROTH LENGTH` DEPTH WSTANNCE TO NEATEST:WELL FOUPNDATTDN PROPERTY UNE <br /> MOU"m ❑YNDTH ^ LENGTH bEPTH D1/TANCE TO NEAREST:WELL MUNDATION PROPERTYLINE <br /> SEEPAGE RTs @-.SPIN �-Y r N2E� Z NUMSE ( XR dSt/WCE i0 NEAil BT:WEIl CST lOUNDATIOH _PROPERTY LINE / r <br /> SUMPS ❑WIDTH LENGTH DEPTH OrSTANCE TO NEAUEST:WELL _POUNDAT)ON FRDPfNTY UNE <br /> DISFOM PONDS ❑WRTH LENGTH ,DEPTH DISTANCE TO NEAAEITT:WALL--FOUNOATION PNDPERTY UNE <br /> I HEREBY CERTIFY THAT 1 HAVE~AAED THIS APPLICATION ANO THAT THE W01K WILL BE DONE 1N ACCORDANCE WTTFI SAN JOAOUIN COUNTY OFDINANCEB AND STATE LAWS,AND FRIIES <br /> AM RE'OU"T10NM OF THEIIAN JOAOUIN COUNTY.HOME OWNER ORUCEHIsEO AGENT'S NONARNfIE CERTIFIEs THE FOLLOWING:'1 CERTIFY THAT INTHE fE1fOFWIAMC E OF THE WOPK fORWHICH <br /> TIME PEFMrr N"WUEO,1 MALL NOT EMPLOY ANY PERSON IN SUCH A MMMER AS TO WCOME SUBJECT TO WOWMA►eS CDFAMNSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HBONG OR <br /> BUS-CONTRACTING MRAT1W CER SEB TI-4 FOLLOWMO:'I CERTIFY THAI'IN THE PERFORMANCE OF THE WOFK FOR IVHICH THIS PERMIT If ISSUED.1 SKULL EMPLOY PERSONS BUIL ECT TO <br /> WOPIL MPE N LAWS OF TIE APPLICANT MUST CALL H HOLQS IN ADVANCE POR ALL REONA IRD NIN�THMs COMPLETE OPAMAING BELOW. <br /> J 3 1 � <br /> HONED x TITLE:� GATE: <br /> cl <br /> ROT PLAN ORAW TO SCALE)SCALE `ro <br /> 1. NAMES Of STREETS ON ROADS NEAREST TO OR BOUNOIIM THE P IOPERTY. S- LOCATION OF HOUSE SEWAGE OWUSAL SYSTEM OR PROPOSED <br /> I. OUTLNE OF THE PROPETITY.WITH DIMENSIONS AND NORTH DIECT10N. EXPANSION OF SEWAGE EMN'OBAL ty@TEMs. <br /> 3. DIMENSIONED OUTLINES AHD LOCATION OF ALL EXISTING AND PROPOSED 61 RUCTURE8. 6. LOCATION OF WELLS WRHNN RADIUS OF ONE HUNOPED FIFTY R.ON <br /> INCLUDING COVERED AREAS NICK AS PATIOS,ONVEWAYS,AND WALXS. THE PROPERTY OR AD"ININS PIIDPERTY. <br /> :.. � .. � . . ........ . . - <br /> :... . :.. . . . C <br /> : <br /> AY Aft <br /> . I <br /> . oEc 5. <br /> ly <br /> RL115LIC HEALTH 8E?Rvrm <br /> ENVIRONMENTAL HEALTH <br /> 30- ...... .. <br /> qt�, r�pR DEP MT IJSf ONLY DATE• l ANSA: ` <br /> APPLICATION ACCEPTER)BY V" '�v'`t"i.�,��j_�"� - �f <br /> 3 L79 <br /> TANK,PIT OR SUMP IPWI[Cn()N BY DAt E / ! FINAL INSPECTION BY ATI,' ` <br /> AMTIONAL COMMUT5: <br /> tAtIC01UN.I'Via ONLY: ADf FAC♦ <br /> EEE"We AMOUNT RMITEO ITEC KMH 11ECBVED tY DATE SR I P1110T MUMMER INVOICE I <br /> Pub.He&"SBrv.•En-Aro.174(3M) <br />