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DESTRUCTION 0 TYPE OF LEPTIC WORK, NEW INSTALLETION 0 NEPA/EL/ADDITION Fit NO SEPTIC SYSTEM PERMITTED IF MANX: SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) WELL LIFT STATION ED SIZE TYPE OF PUMP NO. A LENGTH OF LINES 0 WIDTH LENGTH_ 0 MOTH LENGTH SWAGS PETS 0 DEPTH SIZE LEACHING ERIE REM% Rai MOUNDED PRO TREATMENT PLANT 0 DISTANCE TO NEAREST: TITLE, DATE: 4 2-6, APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 38B, 448 N. SAN JOAQUIN ST, STOCKTON, CA 35201-0388 (2081 468-3420 11011-SEEUNDASEE PINAR EXPIRES 1 YEAR FRIThl DATE ISSUED templet& in TripieateI APPLICATION IS HEREBY MADE TO THE SAN JOAGuEL COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORE DESCRIBED. TINS APPUCATION IS MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE, CHAPTER 5-1 1 10.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION. OWNER'S NAME C.:,_,V.b P 4 ( 1.-- t:, ira.. ,,.L' 15-r , ADDRESS ..-0. r'"sc.,D. c ))0/e.L. 15'5 I '-'7"-1.1' + Ch 95a.) iPMNF AM, ADDRESS/DR APNE .. C 'XI; C -5 . t...1; &r2_i_ 4 N-.4 coy F12..-Et.Te.. 'LA tiF. F,-.1(' LOT SZE CONTRACTOR C-312- 1-).''i vr2-- ADDRESS LICE &;) PHONE %1 . 4750 SUB CONTRACTOR PHONE OTHER 0 SUMP/ 0 WIDTH LENGTH DISPOSAL PONDS 0 WIDTH LENGTH I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORE WILL BE DONE IN ACCORDANCE WITH BAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS, AND RALS AND REGULATIONS OF THE SAN JO NOUN COUNTY. HOME OWNER OFILICENSE0 AGENT'S SIGNATURE CERTIFIES THE FOLLOWTHO 1CSTTIFYUSATINTHE PERFORMANCE OF THE WINK FORWHICII THIS PERMIT IS ISSUED, I SHALl1 NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORICIEAN'S COMPENSATION LAWS Of CALIFORNIEL• CONTRACTOR'S HMSO OR SUB-CONTRACT SIDNATUfhERTwIE9 THE FOLLOWING: 1 CERTIFY THAT IN T HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S 4OFINENSATIOF1AAV8 OF CALIFORNIA. INIE APPLICANT MINT CALI 24 HOURS IN ADVANCE FOP AU. REQUIRED INSPECRONt. COMPLETE DRAWING BELOW. LICE INSINUATION WILL MEWS RESIDENCE 0 COMMERCIAL 0 NUMBER OF LIVING UNITS, MANSUR OF BEDROOMS: CHARACTER OF SOIL TO A DEPTH OF 3 FEET. SEPTIC TANKOREASS TRAP 0 TYPE/MED NUMS131 Of EMPLOYEES, RT/SUMP SOIL CHARACTER: WATER TABLE DEPTH CAPACITY NO. COMPARTMENTS FOUNDATION PROPERTY UNE SAND OIL SEPARATOR !ENCLOSED SYSTEM DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE DEPTH DISTANCE TO NEAREST: WELL POUNOATION PROPERTY UNE DEPTH DISTANCE TO NEAREST, WELL FOUNDATION PROPERTY UNE NUMBER DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE SIGNED A PLOT PLAN DRAW TO SCALE/ SCALE 1. NAMES OF STREETS OA ROADS NEAREST TO OR BOUNDING THE PROPEITIV. U. OUTUNE OF THE PROPERTY, WITH DIMENSIONS AND NORTH DIRECTION. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EX/STING AND PROPOSE° STRUCTURES, INCLUDINO COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALKS. IS 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED EXPANSION OF SEWAGE DISPOSAL SYSTEMS. E. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNOREO FIFTY FT. ON THE PROPERTY OR ADJOINING PROPERTY. 5 c•J PAYMENT RECEIVED APR 2 8 199.5 SAN JOAQU;A, • PUBLiC HEALTH SERMES ENV;RONMENTAL HEAL 7H DV/SCir, -ft-PTC 77s1.4L DIEPARTENENT USE ONLY APPLICATION ACCEPTED BY YesZ DATE: OATS I FINAL INSPECTION BY DATE7' 4f&L 176 ACCOUNTING ONLY. AIDE 1 FACE rE CODE FEE INFO AlApUNT RIM TTMEI <,r,tiwcKs ''''" RECEIVED BY DATE Mt f PERMIT NUMBER WPCS I 1 a t. i ,"'ii(-/‘ 95-7 _lout , 11-/a4.M-_ • 12 ' ' - TANK, PIT OR ROMP INSPECT/ON BY ADDITIONAL COMMENTS: Z_EZ rULY ADDRESS