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APPLICATION FOR LIQUID WASTE PERMIT SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P,Q,BOX 988,904 EAST WEBER AVENUE,,STOCKTON,CA WMI388 (208) 488.3420 NON-REFUNOAKE PERMT EXPIRES I YEAR FROM DATE ISSUED (Celybb IR Tr*snM) APPLICATION IS NERERY MAO!TO THE SAN JOAOUN COUNTY FOR A PERMIT TO CONSTRICT AND/OR INSTALL THE WDRC DESCRNNID.THISAlPIICAYMN IS MADE N COMPUANC!WTN RAN JOAOUIN C'OIANTY DEVELOPMENT TITLE,CHAPTER 9.11 10.0 AND THE STANDARDS OF SAH JOAOUN COUNTY PUBLIC HEALTH SERVICES./- /J rL� e• ENVIRONMENTAL HEALTH OMWTJN. W JOB AOORESS/OR API,_ D=� Ly 7 7U�' O 15-15-7 G 5aLgcj b -r`�f go- 7��LOo _tOT� l' oWAIER'S NAME OG CA ADOREae 2,Q) p f u rc H yC PHOIJ4d 6'^W5e, CONTRACTOR J I G FA U STEN() ADDAEae Al 13OX /78Z Me e" ,4a-••� Sue CONTRACTOR AODIUSB LIC, r=NE �� C? -- TVP(OP 19TIO WORK: NSW NSTALLATION L] NVu1VADdiioAI❑ DSSTRUCTORN❑ NO SEPTIC SYSTEM PERMITTED IF PUIRLIC SEWER IS AVAILABLE WTTIIW 200 FEET OF SUIRONO.1 PSRC TESTNI s 1 MOYI, 1 ` S Apps-ft., �•' INSTALLATION WILL sarvc RESIDENCE P COMMERCIAL 13OTHER❑ [Gran.f.Jf,"'� Numm OF LINO UNITS:—Mumm OF S®ROo1Me: NLRAtM OF WALOYM: CHARACTER OF BOIL TO A DEPTH OF 9 FEET:^ PTT/SUMP BOIL CHARACTER: WATER TABLE DEPTH OGT11C TANKMA15 SE TRAI, ❑TVPEMFO CAPACITY NO.COM'iARTNENTS PRO TREATMENT PLANT❑ DISTANCE TO NEAFWAT: WELL FOUNDATION Pft"prry UNE PU �j RVIES LEFT STATION❑ FLU TYPE OF F%MP SAND OR SEPARATOR ENCLOSED SYSTEAI c JVT'Jl! 'ir:.:,TN�;IU/IC•M� LSACMNO UNE ❑ NO.w LEITH OF UNES— DISTANCE TO NEAREST:WEU. FOUNDATION PROPERTY UNE PKTYU an ❑WIDTH LENOTHT—OEPTH DISTANCE TO NEAP*W:WELL .FOUNDATION PROPERTY LNE AROUND= ❑NAoTH LENGTH_DEPTH DISTANCE TO NEAREST:WILL__FOUNDATION PROPERTY LINE OWAOS PITS ❑DEPTH SIZE _NUNMNER DISTANCE TO NEAREST:VJRL FOUNDATION PROPERTY UNE BRAS ❑T-R WIDTH LENOTN DEPTH DISTANCE TO NEWPE NEAREST:WELL__FOUNDATION PRORTY LNE CNMT1AL PONDS 0 WIOTH LEHOTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE 1 HERESY CERTIFY THAT 1 HAV!PREPARED THIS APRICATiON AND THAT TUE WORK WILL BE DONE IN ACCORDANCE YJITH SAN JOAOUNI COUNTY ORDINANCES AND RATE LAWS,AND RULES AND F90ULATONS OF THE SAN JOAOUN COUNTY.HOME OWHEK OR LICENSED AOEFFT'S MONATIIRE CHWWKS THE FOLLOWINO:-I CERTIPYTHA.T N THE PERFORMANCE OF THE YJONK FORYRIICH THIS PEMMT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNI-A AS TO KCOME SUBJECT TO VJDWP MAN'S COMPENSATION LAWS OF CALIIONWIA.' CONTMCTOPYS MPMLO OR SULPLYNTIUCTING SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT N THE PERFORMANCE OF T/1E MFA FOR WHICH THIS PERMIT IS MOM,1 SWILL EMPLOY FEISONS KISJeCT TO WOPKMAN'S COMPENSATI W1S OF CA IA.• 7 APPLICANT WRIT CA'L 24/LOUIS N MI ADVANCE FOR ALL SU OLED INI&M IONS. COMPLM DRAWRNG BELOW I ti SIONEDK TILE: DATE' 06'0"�' PILOT PLAN(DRAW TO SCALD SCALE -I• I.NAMES OF STREETS ON ROADS NEARSYSTEM EST TO 014 BOUNDN/O SHE PROPERTY. 4.LOCATION OF HOUSE SEWAOE DISPOSAL OR PROPOSED 2.OUTLINE OF THE PIOFERTY•YMTH ONAENIONS AND NORTH DIRECTION. EXPANSION OP SEWAGN DISPOSAL WYS"UG. 7.o11AF]momv OUTLINES AND LOCATION OF ALL OOSTINS AND PONOS®STMICTNES, S.LOCATION OF WSWe VWTMN RADARS Of ONE HUNDRED PITY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DMVEWAYS.MIO WALKS. THE P'IOPERTY OR ADJOINING PROPERTY, .: •-1- — --i- •-I • SRS -5- - ---I-' - 41 II— � I �1Xoa. a1 cc' - I 1 •- -- .i_..tt +-i_. _L.. is ... •' - -1 - r 1 . _ IAT- - ORARTMBJT UBS DAILY APPLICATION ACCEPTED BY DAR. d�G/�I �• (r1V/Y, _I I I L TAM(,PT OR"P INSPECT N 6V DAT/E l�r % FINAL INSPECTION By ApDITIONAI CWAMENTS: EEK �I h E o� a y 34 i ACCOUNTNO ONLY: yyG /J K COOS FEE INFO AMOUNT ADMIT TED CN[CK/ ASH RECHVED BY DAYE /P1tIMIT INVOTC[6 _c ffzo�— -ow '` 2,'(-r'1 (o o GO