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s�gL� Y� <br /> J APPLICATION FOR LIQUID WASTE PERMIT <br /> Vy� SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 988,304 EAST WEBER AVENUE,STOCMN,CA 95201388 <br /> (209)469.3420 <br /> NON•REFUNDAILE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ICIrAp4tf In TripOab! <br /> APRICATION IH IEREBY MADE TO THE BAN JOAQUIN COUNTY FOR A PEF*ArT TO CONSTRUCT ANOMR INSTALL THE WOW DESCRIBED. THSB APPLICATION 18 LI IAIE IN COMRJANCE WITH SAN <br /> JOAQUIN COUNTY GAVELOPUfKT TITLE,CHAPTER 9-1170.1 AND <br /> THE STANDARDS Of SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DRISKIN, <br /> JOB ADDRESIPOR All � ( � C�a R�-CL✓L ri�:( �� Cm, --4 k <br /> _LOT 612E Jr p[.}9z <br /> OAHFR'S NAME&t/,*7-G7f lsF,�L(�¢, P,¢44 ADDRESS_ <br /> Z!_/�.y/�,��Ap 7- 5PH0r1[ <br /> PO <br /> NETCONTRACTOR ADDFE88 LICE T �11`1- � S <br /> BUB CONTRACTOR ADOF%SS- LIC/ PHONE <br /> TYPS OP SATIC WORK: REW INSTALLATION R SPIUMADDITION❑ O"T1WOTIDN a <br /> [NO SEPTIC SYSTEM PfWrTTED IF PUBLIC SEWER IBA AILABLE WITHIN 200 FEET Of BUILDING I RISK TESTIFI I I NOW MANY <br /> �l�eJ�E as LUN��✓✓/��` Em f <br /> ��TAAALLy <br /> INSTALLATION ''' plAlw <br /> � INSTALLATIONWILL SNVE <br /> 1 '. I+ES70ENCE L COMMERCIAL OTHEq C1U-C�'<co",<M I Y/!- <br /> NIIASOI OF UNIIID VMif: NURSER SF SEOROOMS; NOM66U OF <br /> C Of SOIL TO A L7EPTH OF 3 FEET: C!�/ RT/BUAR SOIL CHAJwCTEIl �- WATERTADLE GEIRTN lA,��Z!r•��1'�a'.fc CsJ <br /> n l 10',I <br /> E/T10 T a1sJLSF TRIM TYPEnAFOs -�� t=- CAPACRY 2 <br /> %(ow jL.yj iI� N�O�I�oPsvAarMEFlfe , n"` M1`J U W <br /> TSAgiT PLANT❑ OUSTANCE TO NEAREBT: WELL,/] '� FOUNDATION �J PV PgOPERFY LINE <br /> LFT STATION❑ SIZE TYPE Of AIMP BAND OIL SEPARATOR(ENCLOSED SYSTEM( <br /> / TR <br /> LtA1:PwrD UNE NO.S LENNOTH OF UNE9 Ichor U <br /> 046TANCE TO NEAREST:N4 ��• wjUNDATION�_PROPERTY UNE 35 <br /> FILTER SLD ti WIDTH LENGTH__OEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> MOUNDED ��r❑LWIDTH LENGTH DEPTH DISTANCE TO NEARFRT:WELL _FOUNDATION r���, PROPERTY UNE <br /> Rz � <br /> SEEPAOS TS x,l DEPTH 2.S / wE�� NUMBER�_DIBTANC£TO NEAREST:YYFI✓SD`* FOUNOATIG-2 J� PPgFF PITY LIRE l.S� Z <br /> BUMPS (❑"WIDTH LENGTH DEPTH 0187ANCE TO NFAFFBT:WELL` FOUNDATION PMPEKTY UNE f�! <br /> DISPOSAL PONDS ❑WIDTH LENGTH DCPTN DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> 1 HERESY CERTIFYTHAT 1 NAVE PREPAFED THIS APPLICATION AND THAT 7NE WDW WILL <br /> BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDFIANC£ S,S AND STATE LAWAND RULES <br /> AND REGULATIONS Of THE BAN JOAQUIN COUNTY.NOME OWNER OR LICENSEV AOEKT'B SIGNATURE CERTIFIED THEFOLLOWING:"I CElrfFYTHAT W THE PERFORNIM"OF THE V40W FORWHICH }[1" <br /> THIS PERMIT IS ISSUED.1 SMALL NOT EMPLOY ANY PERSON IN SUCH MANNER AS TO BECOME BUSJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> SUB-COM NATURE CERTIFIES THE WHO.11 CEgT THAT IN THE PERFORMANCE OF THE WOFA FOR WHICH THIS PERMS 98 ISSUED,I RHALL EMPLOY PEF40NO SUBJECT TO <br /> WORIUM 'S COM MLA,' HE APPUC T T CALL 24 HOURS IN ADVANCE FOR ALL RFGUIRSO INAPSCIIONS. COMPLETE DRAWING BELOW. C <br /> SIGNED TR:F_C /lQ! GATE: <br /> PLOT RAN(DRAW TO SCALEI SCAT E 'to <br /> 7.NAMES OF STREETS OR ROADS NEAREST TO OR BOIMNN13 THE PROPERTY. 1.LOCATION Of HOUSE SEWAOE DISPOSAL SYSTEM OR PROPOGFD <br /> 2.OUrU HE OF THE PROPERTY,WITH DRMENSIONS AND NORTH Df1ECT10N. FXPANSIDN OF SEWAGE ONSPOBAL SYSTEMS, <br /> O. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING ANO PROPOSED R TU11ES, t.LOCATION OF WELLS WITHIN RADIUS OF OW HUNDRED FIFTY F7.ON <br /> INCLUDING COVERED MEAS SUCH A8 PATIOS,O..AYE.AND WALILS. ,1Lt��, THE pf10FFFTY OR AD,KIIMNO FTgPEREY• <br /> /7/Q/r SC <br /> I <br /> 1 <br /> I <br /> �. <br /> q . <br /> Oct <br /> �: ,� 3�•IK 251. .:a'vVIHUT,IAA�k rJ,` EM"Ekbl�'ES <br /> 3pc t6 HeA L ri !:S t <br /> POR DEPARTMENT USE ONLY V'!1 7 O <br /> APPLICATION ACCEPT£P BY GATE: O AREA;�Z, +9 <br /> TANK,PR OR SUMP INWECTION BY /// .� <br /> DATE l I FINAL MNBPEDTIDN BY :�,�1.I,t(� � DATE lv' d IfS� <br /> ADDITIONAL COMMENTS' <br /> ACCO'JHDNO ONLY: AUDI FACI <br /> V[COOt FEE INPO AMOUNT RIYATTED CHECILEXASH PXC13VVD BY DAT SR/PHS.ITT NIAUSBR IINOM:E <br /> t -33 8 1 c (o o z37 S <br /> '1156 <br />