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APPLICATION FOR LIHIO WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NON•REFUNDARE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Cemplil•In TT}(bat.) <br /> APPLICATION IB HEREBY MADE TO THE SAN JOAGUM COUNTY FOR A PERILED"TO CONSTRUCT ANDA7R INSTALL THE WORK DESCRIBED.THIS APPLICATION IS MADE IN COPAPUANCE WITH BAN <br /> JOAOUM COUNTY DEVELOPM(E/2 TrrLL cC�HAPEER 9.I 10.3 ND THE STAN)ARDB Of SAN JVAOVIN CWNTY PUBUC HM7H�iEEHMEY.ENVIRONMENTALHEALTH DIVICOUN. ,,r <br /> JOB ADOHEa B/Oq A©JE / —7 C'J 1 {�/� n �'/w v /'-? CSTy V t',G�? 7 LOT BIZf Ale-/y`�� <br /> OYMER9 NAME ADOfiE59 <br /> CONTRACTOR-•�✓C/C NS ADDRESS/Z CC <br /> 6VB COHERACTOR ADDRESS <br /> IRI PL ONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION❑ RIEPASUADOITIO DESTRUCTION L7 <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET Of <br /> BUILDING.) PENIC TESTIS I I HOW MANY <br /> AIWu6en P <br /> INSTALLATION WILL SERVE: RE TilDE'NCE COMMERCIAL 13OTIIER 11NWRER OF LIVING INTI: - NLM69L OF�Z'E.,�DDJRO��OMA -mam OF EAI►LO/Y�EES�: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: illi/e PETISUMP SOIL CHARACTEEi:,� ';? W',TER TABLE DEPTH <br /> SEPTIC TANKAWMASE TRAP ❑T/PEM.IFLI CAPACITY NO.COMPARTMENTS <br /> PKO TREATMENT PLANT❑ OMTANCE TO NDIREIT: YJEA-L FOUNDATION PROPERTY UNE <br /> LIFT STATION❑ SUE TYPE OF PUMP O L1..,�,BAND OIL SEPARATOR(ENCLOSED SYSTf[.II �. <br /> LEACHINO UNE �(�Oy, 7NO.S LEHDTN OF LINES_I` F �Ihle- DISTANCE TO NEAREST:Wflen:ff FOUHDAT.E10/'qp PERTY LINE- <br /> FILTER BED Ll WIDTH LENGTH tlMH !DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH ) DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE /J <br /> SQPAD[Plis MPTH�SIZE �Lp f NUL8iEf1 r DISTANCE TO NEAREST:WELL 1�/ FOUNDATION PROPERTY LINE F��+ <br /> SLUMPS (`II�J WNOTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> dsROSJLL PONDS d WIDTH LENGTH DEPTH DISTANCE TO NEAREST;WELL FOUNDATION PROPERTY WE <br /> 1 HERESY CERTIFY THAT I HAVE FWPAIEO TMS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH BAN K)AGUIN COUNTY CRDINANCEI AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF TIE/AN AW M COUNTY.HOME OWNE RLICENSED AGENT'SCIGNATUF+E CERftF"THE FOLLOWIND:I CERTIFY THAT IN THE FERROPSAANC E OF THE WOR(FORWHICH <br /> TMS i'E/U.VT 8SC ED,1 SHALL MT�EZZY ANY PERW MSUCH A MANNER AB TO BECOME/UBJECT TO WORKMAN'S COMPENSATION LAWS CF CAUFOWA,' CONTRACTOW8 HIRING OR <br /> =0 NATURE CERTIFIES TH FOLL O:I CERTIFY THAT IN THE PEWORMANCE OF THE WORK FON WHICH THIS PE7y.OT IS M"D,I$HALL PAPIDY PERSONS SUb=TO <br /> EMD AH'B COM N LA F C A.' THE APPLICANT MUST CALL 24 I2 IN ADVANCE FOR ALL RSQUIRED WSPECTWNS. COMPETE ORAWINO BELOW. <br /> I ``� 7S & <br /> SIO % TRIP: 'y GATE:_ <br /> _-- POT fR.V!(DRAW i0 SCALE)SCALE <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. IS4.LOCATION OF HOUSE SEWAGE DISPOSAL RYDEIA OR Pmpo tEO <br /> 2.OUTLINE OF THE PROPERTY.WITH DIMENSIONI AND NORTH DIRECTION. EXPANSION OF SEWAGE DNIPOaAL SYMM8. <br /> 3. OIMEHSWNEb CITTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 5.LOCAMN OF WELLS WITHIN RAMS OF ONE HUNDRED FIFTY FT.ON <br /> MCLVDSIO COVERED AREAS SUCH AS PATIOS,ORIVEWAYS,AND WAUKR. THE PROPERTY OR.L.DJOI ANO FROFERTY. <br /> oi i-. . . <br /> rte...., !. . <br /> . <br /> .. } . <br /> Acus e 8. <br /> ............:... <br /> s <br /> .. .. <br /> .... . <br /> .:: pP �NE <br /> OUN't <br /> 54,N�\GaEP�tNFP NU\I�S <br /> Wz1: <br /> 1P N pU9N"'Eh1P <br /> U� .L .. <br /> FCR DEPART USE ONLY �-JT r/ <br /> AT'PICATION ACCEPTED BY /t.^..�1 r\' DATE: V O A A: L t�/1yL7 <br /> TRIS?.df OR Ssukv MSPECTIOH BY �' DATE l I VLINAL INSPECTION BY ATE <br /> ADLNT"IAL COMMENTS: <br /> ACCOUNTING ONLY: ARD• FAC/ <br /> FE CODE FEE INFO /MOUNT i7EO CIEDK! ASH REC EIVm BY DATE SR(EE,NElI.q ER I.NVOICCI <br /> a v 2s3 <br /> Pub,Health Sarv.-Enviro.174(3/96) <br />