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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> C." 304 EAST WEBER AVENUE,STOCKTON, CA 95202 1 V <br /> ` (209)468-3420 <br /> ROR REFUROARLE PERMIT EXPIREI I YEAR FROM 9ATE I;IIIIE9 <br /> (CmViftl 1F TIi'GatF1 <br /> APPLICATION M/EPWRY MADE TO THE FAM JOAOUN COUNTY FORA PEIFNFT TO CONSTRUCT ANUMM P497ALL THF WORK DESCRIBED. TTN APPLICATIORI M MADE M COM`n ANCr%NTH SAM <br /> JOAOUN COUMY OEVFLOPMEIET TITEE.CHAPTER 9-1110.7 ANO THE STANOARCS OF SAN JOAOM COUNTY PVKM HEALTH WRYWFS,FNVMRONMENTAL HEALTH ORAOON C <br /> JOB PANDWSOMPt X-Flf =� S�J t it//�2 T</,!A xv b cm X194�iTr LOT NZE� � <br /> 's <br /> owNEnNwF_ t�. �/j9�i/� Aoa+Eae j T:T-� <br /> COMRACTOR ADC"88 <br /> FUR CONTR/ICTOA ALXMSR LICE T/'RONE <br /> TYPE OF&rpm WRMRNEW MBTALLATICM❑ MPAWADOITION OFITRUCHDN❑ <br /> NO PEPTIC SYREM PERMITTED IF WBL1C SEWER IF AVARABLE WITHM 2DO FFFT OF BtNLDIM.I POIC TWTPI 1 1 WiW MANY <br /> MOT ALLATION WNL DINVB: REIMNACi'WJ COMMEICIAL❑ OTHFA ❑ <br /> IF{FIrU of UNNO tIITI: l NUMB9L 9-F SFDIIODRNB: ? NU A M OF FFAPLOYM: <br /> CHARACTFIR OF Bal TO A Dt"M Of J FTET:-- /Z/lb�Z PIT/BUMP S01L CHAMCTFT: WATER TABLZ D[PTH <br /> PEPTIC TAN-ftWW-JF TMP ❑IYPEAAF9 CAPACITY NO.COMPAITIABIT0 <br /> P}LO TFIFATMOFF RAw ❑ OISTANCF TO NFAF&INT: MARL FOUNDATION PROPERcn'LIF <br /> UFE]'A17TnATTKppSIR❑ FRE TYPE of rwr RANO OIL SEPARATOR IENE:LOBED SYSTEMI r <br /> /LiAOMNO-If11E - ❑ NO.A LtNOTH OF LNEB_ T OMTANCE TO NE/VEFT:NFLL��FOUNDATpN - PRD1'EILTY UME <br /> FETM BED ❑wvr" LEIPOTH_ DEPTH DISTANCF TO NEAREST:WELL POUFrDAT1014FROPE "LFa <br /> MDIBFOm ❑WIDTH tDMTH_!__D!►TH D1fTANCE TO NEAIEFT:WD.L POL"MATIDN PROPERTY Lf1F <br /> BSWAOS WTF ❑DWrH WZE _WRAFER OIBIANCE TO WAAF&T:WELL VUWDATWN FOM"LM- <br /> SUM" ❑WIUTH LENGTH__OEPTH DISTANCE TO PRAFSST:WELL_-POUIDATIDN FFO"""LATE <br /> DISPOSAL PONOf ❑WDTN UNVTH .OEPTN OIRTANCE TO NEAREST:WELL _P01fI>AT1ON PROPERTY uw <br /> 1 HEREBY CERTIFY THAT 1 NAVE PREPARED TIN MW%ICATION AND TT Al THE WOW(MALL BE DOR*N ACCORDANCE VMTN Wt JOAOUM COUIM 0009/WCE7 AND SfATF LAWS.APO RIRIS <br /> APO WGUJRTIDFRI OF TMF BAN JOAMM COUNTY.HOME OWNER ORLICFP/SFD AOFNF'B SIGNATURE CSRTWE•THE FOLLA)"01d:'1CIRMY THATM THE PEM"*"VRCF OF THE WORK FOR MARCH <br /> THO POWR IStopiM.1 SHALL NOT MMOY ANY PERSON M SUCH A MAi'SIR AS TO EECOMF SUBJ[CT TO WOWMANrS COMPFNBATION LN"OF CAEfORNIK' CONTRACTORF f"M OR <br /> SUB-COWPLACTIHO SIONAft11E COTTOWS THE POLL01NN0'1 CENTWY THA.'M THE PETIFORM AWF OP TNF WORK FOIA WHICH THIS PV"T W WrJED,1 MNL nM%OV"MONS SMECT TO <br /> OUAAN^S COMPOSSATION LAWS OF CALIF M A.• THF AP"MANT MUST CALL N HOURS IN ADMAPICI FOR ALI.IF1dMm fMP`710MS. COFMIITE OIVIWRID BROW <br /> WW <br /> //�/' i/ 7^ <br /> 1RMgpR _ �_� ./� /` � TRlI:� l�-,/9�-1 , /' est, _ DATE: <br /> PLOT PLAN DRAW TO SCALE)WALE_-"W <br /> 1. NAMES OP STREETS OR ROADS NfAREFT TO OR BOUNCING THE PROPERTY. F. LOCATION OF HOUSE WWAOF OIBFOSAL SYSTEM on P'MP02M <br /> 2. OVILv NC OF TTE PROPERTY.VIRTM DWFW=Nf AND NORTH dRECMN. EXPANSION OF SFWAOE DFKDSAL MIEYS. <br /> 7. ONAENWONM OUTLNIEF AND LOCATION OF ALL EMSTNO ANO PROPOSED STINCTVIEL, F. LOCATION OF VAX"VWMW)MOM Of ONE NUNOFEO FIFTY R.ON <br /> NOULRW40 COVERED AREAS SUCH AS PATIOS.URIVEWAYB,AAO WALK"- THE PROPERTY OR ADJODRM PROPERTY. <br /> e� <br /> .T.. o I <br /> .. ...... V ' <br /> Ir <br /> c _ _........,............_ RE <br /> . <br /> �� .. . Nov <br /> Puslic <br /> �ITMBlI UBE ONty <br /> APPLICAPON ACCEPTED BY >`^ - I DATE: 1 l Ml A. <br /> TANK.FTI OR BUMP NBPECTRl11 By CATF FWALWSRFC`tWH BY <br />