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APPUCATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION nh/M�O�� 304 EAST WEBER AVENUE, STOCKTON, CA 95202 �j/Gtr` (209) 468.3420 NOW NUUNDA UNIT EXPIRES 1 YEAR FROM DATE 1 SUED ICBFEp61tB In Tr*AuL) APPLICATION rLl HEREBY MADE TO THE BAN JOAOVIN COUNTY FOR A PERMrT TO CONSTRUCT AIOIOFD INSTALL THE WOW DESCRIBED. THIS APPLICATION IS MADE IN COMPUANCk WITH BIW JOADLIM COUNIY DEVELOMAENT TTTLE.CHAPTER 9.1110-3 AND THE BTA#DA OF SAN JOAOUM COUNTY PUBLIC HEALTH SERVICES.ENVOICRWINTAL HEALTH DIVISION. 11 T JOB ADbRFSSfOR APNO C) ��NtJ'C c w _ CRJ–Y LOT OWNER'S NAME L1` �.1+ i /T ADDRESS AbN— CONTRACTOR ••�Cr,w(.-AoofEea 1T+/�J 14 f�•'.�P.,l'�...1 r1^ _ �►-%/S��"�_PiIONE SUB CONrtu1CTO�R 'T'^ ADCYIESS LOC/ ',NONE TYPE OF SEYTOC WORK: NEW INTALLATION w RVAIROADOTION ❑ DESTNUCTION❑ IND SEPTIC SYSTEM PEOwffTED IF P45UC SEWER Ill AVAILABLE WITHIN 200 FEET OF RUILDN0.) PY1C TDSTI&I I I WJW MANY Applla n F_ INSIALLATION WILL B@LVE_ RESIDENCE 21 COMMERCIAL ❑ 01HER ❑ NUMBER IN,UVINO LNSTS:�_ ,(LIMBER OF 1111DROOSAG: FRlmm OF EMPLOYEES: CHARACTER OF BOII TO A DEPTH OF J FEST:_ 4'— PIT/SUMP ISM CHARACTER' WATER TABLE SEPTIC TA NJOPIEME TRAP ©TV wwa 6 ::•�:•-i le. CAPAC(T'/• //U rJ No.cOMPAER'AmTi PKO TREATMENT RANT❑ NoTARCE TO NEAREiIT: WELL Air, FOUNDATION PROF""L)NE UFT BTARON 0 517E TYPE co,Pum�r —SAND OR SEPARATOR(ENCLOSED SYSTEMI , LEACHING UNE I'D NO.a LENGTH Of LINES_zl ! f Ca DISTANCE TO NFAMwr'WELL JgL�!-[f t FOUNDATION, PROPERTY LME FILTER BED ❑WIDTH LENGTH_ DEPTH DISTANCE TO HEAREBT:WELL FOUIIDATION FROPEITY UNE MOUNOW ❑~" 1.FNOTH_ DEPTH DISTANCE TO NEAREST:WELL FCUNDATIDN VVIOPOITY LINE SHlAOB PITS ❑mpTl1 BRE __NUMBER DISTANCE TO NEATEST:WELLFOLIFDAT1011 PROPERTY UNE ♦ft*AFB ❑VVIOTH LENGTH _DfPTH DISTANCE TO NEAREST:WELL _FOUNDATION PROPERTY LINE OISPOSAL FONDS ❑WIDTH LENGTH DEFTH DISTANCE TO NFAMST:WELL _FOUNDATION PM OFERTY LINE 1 W EBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AID THA'C THE WORK WSL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY OIbWANCES AND STATE LAWS,AND Alt"S AND REOUI.AT101M OF THE LAN JOAGUIN COVNTY.NOME OWNER DEI LICEH SED AGENT'S BIONAT VLE CERTIFIES THE FOU&NINO:'1 CEMIFY THAT M THE PERFWMIANCE OF THF WOFK FOR V*WH THIS PEFRIR HI t96UTTI,I&CALL"Of EMPLOY ANY PERSON RM SUCH A MANVRA AS TO BECOME SUIL)ECT TO WN)MkwcB COMPENBATKW tAWS Of CALIF000A.' CONTRACTOR'S F wow OR OUBSOMIIACTING BIGNATUAl CE7 "Wf THE FOLLOWING:I CERTIFY THAI-IN THE PERFOFOAANCE OF THE WORK FOA WHICH THIS PERMFT It ISSUED,I&CLL EMPLOY PERSONS BLO&MCT TO WORKMAN'@ COMPENSAT LAWS OF CALIFORNIA.' THE APPLICANT MUST^ALL 21 DV HOURS W ADVANCE P0F1 AL:ASOL✓•1®INSFBCTIONS, COMPLM DRAWING Ba.OW. o / � &ONED X TILE_ �1/: L,' DATE: / �j— PLOT PLAN(DRAW TO SCALF7 CALF! 1• NAMES OF STIETTS OR ROADS NEAREST TO OR BOUNDINO EHE PROPERTY. 4. LOCATION OF HOUSE SEWAOE DISPOSAL BYBTEM OR PROPOSED 2. OUTUNE OF THE PFOPERTY•WFTH dMEN100NI AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL IYBTEW. ` J. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, i. LOCATION OF WELLS WITHIN RAMS OF ONE HUNDRED FIFTY FT.ON �\ INCLUDING COVETED AM"OUCH M PATIOS.DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOWA PROPERTY. LIAO _............. ....... 4 . ... ......... _. ... o PAYMENT r JAN 6 2000 . ... . . BAIf��;Y,QpWN CCAUH7Y `9 LIC ENVIRp�4AENgMFA�TH f FON D�A/rTMENT USE ONLY �.�rlf�l _ J1fPF'LICATION ACCEPTED Sv DATE: �`A' ��r�-yy.y�,��,� TAME,RST OR SUMP*W'ECTION DAYF ! / FINAL MISPEC N BY DATE_/1 0 1 CJ J �r —t ADDITIONALGOMMElRS: I•_/O•Z��i7vIE TLL 's Wft - 2_ oljRT �-1 ACCOVNTI!M ORKY: AID/ FACS K CONOE FEE Iwo AMOUNT PMMSTFD - AAH RECEIVED SY DATE 1l1vOKE Do l2� , Pub,Haab Serv..Emiro.174{3)96)