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APPLICATION FOR LIOUIO WASTE PERMIT { SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES (�I ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468-3420 NOM-REFURDABLE PERMIT FMRE3 f YEAR FROM DATE ISSUED M,tuWJEEE IR TrlPlfoTN ..— APPUCATN N IB HEREBY MADE TD THE BAN JOAO""COUNTY FOR A PERMIT TO CONITRUCT ANDNA INSTALL THE WORK DESCIWED. THIS APNLCATION I$MADE IN CONAPUANCE LITH SAN JOAOUIN COUNTY DEVELOPMENT TTTLL CHAPTER 8-1110.3 AND TH IITANOARDB OF TAIL JOAOUIN COUNTY PUBLIC HEALTH SERVICES,EI VMWA04AL HEALTH OIYIPON. �y. JOS A•OOREG MP APNP i Y" 47 CfTY ��Q�C. LO!Suk-rh c- OWFER'S NAME V C_t ADDRESS l 6-c"-co {� f j ,`o0 ,�( PIIDNE CONTRACTOR_ 4Y V`L S�^�. ?O �J'L, ADDRESS R 6 j V a (.O l PFIO SOB CONTRACTOR JPDORF9S UOI PNORE TYPE GF mo—wom: NEW MSTALLATTON❑ RVNRVADOLTION DISTIUICTION❑ WO 6ERIC SYVMM PEFARrTED IF PUBLIC 6Z-ZA IG AVALASLE WTTHIN ZOO FEET OF SUNbN 4Oj PER.TSATH)1 1 NOW MANY APFBsiew S INSTALLATION WILL SONE: RESIDENCE& COMMERCIAL❑ OTHER 13NUMBER OP WINO U M T S: N...OF BEDROOMS:,:"IF1Ae061 OF EMKOYEES: CHARACTER OF W R TO A bEPTH OF-3I FEET: PTAnWP SOIL CHARACTER' WATER TABLE DETTF SEPTIC TANRIOREAJMAP AP U TYPEmm CAPACITY NO.C0WARTMCNTB PKO TMATMENT RJxT CI DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE LIFT STATION❑ .SIZE TYPE OF PUMP OAANOO OIL SEPARATOR 1ENCLOSED SYSTEM) WCll/q UNE �S(HO.M LETIOTH OF UHES" I� _l(/(/L gSTANCE TO NEAI¢HT:WEu:ZZ `L FOVNPATgH, CSS PFOFERfY UNE P IRLTEG am 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATKNN PROFIRFY LINE MOUE/OED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREBT!WELL FOUNOATION PROPERTY UNF ,llvm E me ❑DfT SIZE NUMBER DISTANCE TO NEAREST;WELL FOUNDATION PMOFERTY UNE SWM 0 VAOTH LENGTH OFPTN bISTANCETO NEAREST:WEU—TONJNOATION PROPETYLINE OUNIOI AL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUFIDATGON P OPERTYURE I HEREBY CERTIFY THAT I NAVE"PARED TMS APPMAT'ION AND THAT 11JE WORK WILL M DONE IN ACCOP ANCE WITH SAN JOAOVIN COUNTY DRU(NACES AND STATE LAWS.ANO RVLES AHD REOVI ATIONS OF THE SAN JOAOUM COUNTY,NOME OWNERORUCEHGED AOENIT'S SHINATURE CERTIFIES THE FOLLOWING:9CEITRUYTHAT IN THE P[FFORAANCE OF THE WOPK FOR WNGH TWO PERMIT h RWED,I SHALL NOT EMFEOY ANY P19GBDN M INCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CNIFLEMA-' CONTMCTOR'S HNWM OR SUB•COHTRACTiNG CERITFE8 THE FOLLOWKNG:'I COMFY THAT IN THE P1�ORMANCE OF THE WOW POS WHICH THIS PERMIT IS MOVED.1 SHALL FMMDY PEIIBONS SU&WCT TO Y+OR(MAN'S COM T (NL'•,AM{B'(O-F CAL)FORNI •TTPIE APPLICANT MVST CALL 20 HOURS IN ADVANCE FOR ALL REOUNRID INSI ICTIOSS.COMMS TE OMWINGBBELOW- /yY STONED% "'�` - 1' TRtE: 1 C� DATE: ROT PLAN 40FLAW TO SCALE)SCALE 'to t.NAMES OF 6T1�TB OR ROADS NEAREST TO OR BbUNO1N0 TIE F7IDRITEY. )•4.LOCATION OF HOUSE BEWAjm DISPOSAL SYITEM OR PRDPDSFD 2.OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH D'"EC7pH. WAN ION OF SEWAGE dBIK10N.IFYBTEMB. 3. DIMENSIONED OU'"ES AND LOCATION OF ALL LVITWO ANO PIOPOSEO STRUCTURES, P r'-�;, *} R'S.LOCATION W WELLS OF OHE HUEi1/ED FIFTY FT.ON INCLUDHO OOVOSEO SUCH AS PATIOS,ORVEWAYS,AND WALKS. THF FlIORF'RTY OR AD.IO .Mc �rY 1999 - NVJ140NIy`N is� ?it�jVSycl :.. .. . c . Y�NO . Y. ;.. ....3'. � �. .. `..........F.. j WE OE0.Y APPLICATION ACCEPTED BY //-7FVAV,'�ly, ATE 11 TM4K,PIT OR SVMP INSPECTION BY DATE J I FINAL WMCTION BV GATE ADDI"TIONAL COMMENTS: ACCOUNTING ONLY', AIDJ FALJ 1'6 CODE FLBUMG MAOLMIT"ilmINCL N HEC Gym BY OATT ONt FiSIIT NUMBER NNY'OXIFJ Pub.HedU1 Serv.-Emiro.174(&95;