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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388, 446 N.SAN JOAOUIN ST., STOCKTON,CA 96201-0388 <br /> (209)468.3420 <br /> NOW REM NMEE PEAFAR EXPIRES i YEAR FROM DATE ISSUED <br /> APPlICA71'JN IB PfEiEBV MADE TO THE SAN JOAQUIN COUNTY FORA II'ARI Lata in TrpicnuI <br /> JOAQUIN COUNTY oCvEL>7P.IENT TITLE,CHAPTER 8-1110.3 AND THEESTAN TDAADS OF SAN JOAQUIN COUNTY TPUBLIC HF LLSEAVICES,ENVIRONMENTAL HEALTH HE WOHK DESCRIBED. THIIS APPUCATION IS MADE <br /> p�NANCE ONTO{BAN <br /> JOB ADDRESSJOR APNA L e `� g`;1>i�14 E•S 1,f'a CITY C'CtEuG.4.+ `r�I--�'C� <br /> LOT S <br /> r LZE <br /> ONINER'S NAME Q7'V4)g..ITtc ��.)v yy"•r �/ F <br /> ADDRESS V�C`1C. iso/n •_j t1;-E.r l/) _rIZ(•�JPHONF <br /> COMPACTOR C-3 P—�V�Z-- r,ADDRESS LIC ��Ipp, FHONE "IC:'2��9°7�iU <br /> SUB CONTRACTOR ADDRE6B UCF <br /> F7gNE <br /> TYPE OF SEPTIC WORK'. NFW NNSTALLATION❑ RIEPIW/ADDinom DESTRUCTION❑ <br /> iN0 SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVALABLE WITHIN 200 FEET OF BUIlDING.i PB{C TESTI.I f 1 NOW MANY <br /> APPYeStlon <br /> IN61Al1ATON WILL SBNE: RE8IDETICE❑ COMMERCIAL❑ OTHER❑ <br /> NUMBER OF UVINO UNITS: NUNISER CGP BEDROOMS: NUYHIER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: RTNSUMP SOIL CHARACTER: WATER TABLE DEPTH_ <br /> SEPTIC TANKAWWAst TRAP ❑TYPEAAFO_ CAPACITY NO.COMP/ATMENTS <br /> PPLO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPEFITY LINE <br /> LIFT STATION O SIZE TYPE OE PUMP SAND OIL SEPARATOR!ENCLOSED SVSTEMI <br /> LEACHING RINE Cl NO.&LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> FTLTM SED 13WIDTH LENGTH___DEPTH DISTANCE TO NEAREST:WELL FOUNOATONPROPERTY LINE <br /> MOUNDED 13LL WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WEFOLNOATION PROPERTY UNE <br /> GWA.GS PRS ❑DEPTH SIZE NUMBER DISTANCE 70 NEAiM-lA IlL _FOUNDATION PROPERTY UNE <br /> SUMPI ❑WIDTH 1910TH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION POPERTy UNE: <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT]HAVE PREPARED THIS APPUCATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE W.TH BAN JOAQUIN COUNTY ORDINANCES AND STATE AWB,AND RULES <br /> AND REGULATIONS OF THE SAN JOAQUIN COLMTY.HOMEOWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHATIN THE PERFORMANCE OFTNE WORK FORVANCH <br /> THIS PERMIT is ISSUED,I SHA NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WDwuAI'S COMPENSATION LAWS OF CALIFORNIA-* CONTRACTORS HIRING OR <br /> WORKMAN'aSUB-CONTRACT 91p ATI EITIPEB THE FOLLOWING:"I CERTI Y THAT IN T'14E PERFORMANCE OF THE WORK FOR WHICH THIS REMIT IS ISSUED,I SHALL EMPIDY PERSONS SUBJECT TO <br /> WOFKMAN'8 O SATO OF CALIFORNIA'7HE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL RFOURED IN"WTIONS. COMPLETE DRAWING BELOW. <br /> SIGNED X 7RLL'. 74641.-YY YJIi�-S.O.TI`�_ OATS a 24--15- <br /> PLOT <br /> 4-'ySPLOT PLAN(DRAW TO SCALE)SCALE <br /> 'f6 - <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PIO10gM <br /> 2.OUTUNE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS, <br /> 3. DENSIONPO <br /> ED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6.LOCATION OF WELLS WTIfIN RADIUS OF ONE ILUNDIRED f1FTY FT.ON <br /> INCLUDINGIMCOVEPID AREAS SUCH A8 PATIOS.DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJONW/G PROPERTY. <br /> !'Iss o <br /> .. . f ' <br /> Q <br /> PAYMENT. . . <br /> RECLcivEA <br /> -->�--- A p R 2 S 199 <br /> 3AI,.1C <br /> F>U8 1 AQUrN I b uf4l'x. .: <br /> L C HEALTH S <br /> ENV;RQNMtNrAL NERVtCEg <br /> EA 7 <br /> 1`90 DEPARTMENT wE ONLr <br /> APPLICATION ACC FPTF.O By L R L DATE' <br /> TAM(,PT OR BUMP INSPECTION BY DATE 1 1 FINAL INSPECTION BV <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING ONLY: AIC/DO <br /> IC/ FACE <br /> >2 COOP REF INFO ONT REAITTRD I6KNI RECHVm Br DATE 8R lI'6MAT MIS�M9l INVOICBS <br /> t 4 s �r U its s <br />