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APPLICATION FOR LIEIU1D WASTE PERMIT}�— <br /> t SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES d <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.SOX 588,304 EAST WESER AVENUE,STOCKTON,CA SMI-388 <br /> (209}48934211 <br /> RDK•11011N0ARtf PERMR EXPIRES t YEAR FJ_9IQF IIALg ISSUED <br /> (t.apl.te iR 7FyRat.1 <br /> APFIUCATTON 18 NERERY MADE TO THE SAN JOACUIN COUNTY FORA PEPAST TO CONSTRUCT ANOIOR INSTALL THE WORK DESCRIBED.THIS APPLICATION If MADE IN COMPLIANCE WRN SAT( <br /> JOAWIN COUNTY.EVFIOPMENT TrYLL./ TE <br /> .EE..CHAPTER 9.11110.3 AND THEE/SRDRNC <br /> STANDARDS OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES. <br /> EKVW-OW jNM(WrAL HEALTH CrAVION. <br /> AB ADOAEBB/0R DIY J T+"ri+J CJK CITY��C.LJC !C_•YL./ _ _EAT 812E <br /> PHCNE`ji' <br /> CWMEP'e NAME G— ADptE68 /♦ �`� <br /> CONTRACTOR_ , AOCREBB <br /> 8U8 CONTRACTOR ADDRESS LIS! __PRIWIE <br /> TYPE OF BFPT)C WOW NEW POTALLATON❑ RE►AUUAOdTIONXI pUTHUOTION <br /> NO SEPTIC SYSTEMA PERMITTED IF PUBLIC NEWER GI AVAILABLE WITHIN 200 FEET OF WK,04NG.I MW TbT1FI T 1 NOW MANY <br /> APMwias� <br /> INSTALLATION WILL IIOIVE: AESIDENCE)11,�COMMERCIAL❑ OTHER 11 <br /> NIL18E1 OF LIVING UNITS:_NUMBER OF iEDIROONM:�•�NUMSE R OF OAPLOYM7 <br /> CHARACTER OF SOIL TO A 09PW OF I[3 FEET:_ PIrMJW SOX CHARACTER• WATER TANLE DWTF(, <br /> K►NCTANKIORNAGE TRAP to TYPEJMFO CAPACITY \ NO.COMPARTMENTS <br /> WO"WATMENT PLANT Q OmTAN'CE`TO NNAKOT: WELL FOUNDATION PPIOMRTY UNE ll"" <br /> LIFT STATION❑ BLZE NPE OF PUMP BAND OIL SEPARATOR JENCLOSED BYBTEMI -7 <br /> LWNING LING O.•LENGTH OF UNE ---B Ap DISTANCE TO NEAREST:W[LL ` FOUNDATRMI PROPERLY UNE <br /> FILTER EGD ❑WIDTH LEWTK___DEPTH DISTANCE TO NEAREST:WELL PKIUNDATION PROPERTY LINE <br /> MOUNDED -0 WIDTH LENGTH DEPTH DISTANCE TO NE/NEST:WELL _FOUNDATION PROPS"LINFEA <br /> SDDAOE RT. ICJ OO�TN7,5 BFR_ NULGBFR_�deFALCE 70 NEAIEBT:WF31FOUNDATION fMOPEIIFY U[B: <br /> RMAS D LWOTH LENGTH OEPFTT DISTANCE TO NEAREST:WHL FCUNDATIDN PROPERTY LIME <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:YIELLL FOUNDAT*lN PFWPERTY LNIE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THI WORK WILL BE DONE IN ACCORDANCE'AITN SAN JOAOUFI COUNTY OROINANaX NA RTATE LAWN,AND RULES <br /> AND REGULATIONS OF THE SAN JOAOIIN COUNTY, AIJC&XSED AGENT'S SIGNATURE CERTIPIES THE FOLOWJNG:'I CERTIFYTHAT IN THE PEMORNAN[E OF THEWOTK FORWHICH <br /> THIS PERMIT 18188U 1 SHALL NOT EMPLOY ANY PE}ISON IN A MANNER AB TO SECOME SUBJECT TO WOWMWS COMPENSATION LAWS OF CAUFOIWIA.' CONTAACTCR'B"FANG OR <br /> SUBCOHTRACTI BI 'ETITF S' FOLLOWING:'1 THATIN'MK PEIRFORI.IANCE OF THE WORK"WHICH TWO PERNNT IS ISSUED.I SHALL EMPIDY PERSONS INISJECT TO <br /> WOtlKAIAN'S LLFEN ION M RALRT CALL tG RIOUK N ADVANCE FOR ALLGUIRER TNSPE'C IONC COMPLETE ORAWSKI RELOW. <br /> I SQ <br /> SION[O TrfLE:l� <br /> DATE: <br /> �— 1 f <br /> PLOT PIAN RJRAW TO SCALEI SONE__'Io <br /> ]. 9 OF ST/1EET9 OR TO OR BOUNDING THE PROPERTY. A.LOCATION OF HOUSE SEWAGE OISPOSAL CM84 OR PROPOSED <br /> i'UTLIHIE OF THE PROPERTY,WITH DIMEw"ONS AND NORTH bNRCTNNN. EXPANSION MB <br /> OF SEWAGE DNIFOSAL BYSTE . <br /> 0.OBAENWONED OUTLINES AND LOCATIM OP ALL FXIBTM AND PROPOBED STISRCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNbRED FIFTY FT.ON <br /> WCLUD04 COVEAEO MEAS SUCH AS PATIOS.DRIVEWAYS,AND WALK%. THE PROPERTY OR ADJOININa PROPERTY. <br /> Qp r, <br /> I <br /> RIF <br /> MAY 19.-199T <br /> .191;1 la%4,,J`N }-�?VIE3 <br /> 'VY riF;tviwlEN k .� <br /> _......_ _. ._ ...................:..... <br /> FOl1 DpAR TMENT RUNG OMY <br /> 4-AlACCEPTED BY DATE:SVMPSPERION BY Fwu DATECTION NYowl-V <br /> ,.JmwNT S: F <br /> ACCOUNTING ONLY: AIDE FACT <br /> AE CODE FEE INTO AMOUNT ROATTED HBC /CASH AECOVW BY DATE M i FEIB.T NLLMM RNYOIC[/ <br /> n a <br /> V \� <br />