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APPLICATION FOR LIDUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTHDIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NDN-REFURDARIE PERMIt EXPIRES 1 YEAR FROM DATE 148UFD <br /> (Cf NWlStS M TFIFRca14) <br /> A KATNIN M HL9EBV MADE TO TIE BAN JOAOIBN COUNTY FORA PEWIT 10 CONSTRUCT AND V R INET ALL THE WORK,DUCIOBEO. THFf AFFUCATION RI MAGE W COMFUANCE WFTH BAN <br /> JOAOUN COUNTY DEVELOPMENT <br /> TRUE,CNAP111A 9-1110.3 AFM/THE Bf ANOAROB OF SAN JOADUN COUNTY PUBLIC HEALTH B[EIYIM$t.ENVMNMEMK HEALTH DIVISION, <br /> JOB ADDRFSStOR ARM /��G' _� f�:'-:/ /�-�<'/ CITY ' � .CBOT SIZE, <br /> OVJNER'f NAME (�-v�IV t AppiE56 3 JI�✓• RHONE L. -✓L G <br /> CONTRACTOR_ r-�Y�".'�../r1 �- wl G=?�' // AWRFSG /r % l',r. e _?=,<• N.•N. uc0PHONE Ji/�7�.'...s/L•[,i., <br /> SUB CONTKACToR ADOMSt UCF RHONE <br /> TYPE OF SEPTIC VM K: NEW WSTALLJITION❑ A�NmADOTION ❑ OEATRLMMN C <br /> h <br /> NO SEPTIC SYSTEM PERMITTED IF MSUC OYYEA IS AVAILABLE W IHN 20D FEET OF BUILJING.I I MEF Tz"Iml 1 I NDW MANY <br /> INBTAUATION WRL BFNVE: RESIOEME❑ COMMERCIAL❑ OTHER❑ <br /> NUMSKR OF UVINO UNITS R—fift OF BEDROOMS: —NIAWBBR OF 9APLOYEES: <br /> CHARACTER OF BOIL TO A OEPI N OF G FEET: PFTMUMP SOIL CHABACTTFI WATER TABLE DEPTH <br /> SEPTIC E <br /> TAHBIOABE TRAP Q TYPEAIFO CAPACITY NO,COMPARTMENTS_ <br /> ►KO TREATMENT PLANT CI DISTANCE TO NEAP=T: DVELL FOUNOAIION PROPERTY UNE <br /> Un STATION 0 WE TYNE OF PUMP SAND OR SEPARATOR S:NCLOGM IIYEREW <br /> LEACHNO UNE ❑ HO.A LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION__PROPERTY UNE <br /> FTLTW BED ❑WIDTH LLHOTN OET^H DISTANCE TO WAREOT:WELL.FOUNDATION PROPERTY UNE <br /> I <br /> MOVNDmVA <br /> f❑f11 pTM LEHOTN DFFTN ORE <br /> K6FANCE TO NEA67:WEU,_FOUNDATION PROPERTY UNE { <br /> SQPAOE RTS L DEPTHITZE NUM6EA DISTANCE TO NEAREST;WELL FOUHOA P PqF{RTU UHF <br /> BLMN p WIOTH __—_LENOTN DFPTH DISTANCE TO NEAMST:WELLFOUNDATION PROPERTY UNE ' <br /> DISPOBAL POROS ❑WIDTH LENGTH DEPTHOSTANCETO NEAREGT:WELL FOUNDATION PROPERTY LINE <br /> I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOFK WILL BE DONE N AF,COROANCE WTTH SAN JDAWN COUNTY ORDINANCES AND STATE LAWS,AND MAES <br /> AND REOIRATIONI OF THE BAR JOAOUINCOUHTY.HOMEOWNERORLICIT—D AOENT'S SONATURE CERTIHES TIE FOLLOWOIO:'ICERT.F THAT N TH[PFFOMUNCE OF THE WOFOL FIDRIAWH <br /> THII PERMIT IBISSUED,I SHALL MOT EMPLOY ANY PERSON IN <br /> BUCK A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALDOPNIA.' CO WRA ""NOCTOW9""NO OR <br /> 9U 12NTIIACT WO BWNATU E CMVrEB THE FOLLDMIRIO:'I CERTIFY THAT IN THE FEWORMANCE OF TH[WOW DOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S PAR <br /> CONBAYMN LAWS OF CAUPOANIA.' THIS APPLICANT MUST CALL b HOER/IN ADVANCE FOR ALL RSO AREO"10,M IONS. COMPLETE DRAWING BELOW- <br /> , <br /> SMNED% ✓ L�..� ti. —_TRIP C r/ ��, /4 N/✓,/i A_. DAT E'.`..�f <br /> PLOT PIAN IDRAW TO SCALE]SCALL <br /> 1. NAJAES OF STIEFTB OR ROADS NEAREST TO OR B01lNN <br /> OO TIE PROPFRTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SVRTEM OR PROPOSED <br /> Z. OUTLINE OF THE PP OPERT --I--W EXPANSION OF"WAOE DISPOSAL BT—a. <br /> J. OWEHSIONEO OUTLINES A S.LOCATION OF WELLS WRHIN RADIUS Of OFIE HUNDRED FIFTY FT.ON <br /> INCLUOINO COVETlO AREA '"1OFERTY OR AD 1000-G PFFONRTY. <br /> ............. E ......,......j.....:........ <br /> It <br /> I <br /> rlue>2 ru I ` .... <br /> :.. sarin-a-1 <br /> I . <br /> ' � V <br /> .. ...... <br /> . 1 <br /> _...... .•. ICIR+NPY LC 199910" J <br /> ,Jy..�V L <br /> .. <br /> DESI G"A ,1•or MAR.. _21999 <� <br /> 'h�'iYG,J1JFNYA,+ii-gl <br /> O <br /> /\ ^l pDp p, TUBE OMIY C <br /> APi`UCATION ACCEPTED BY <br /> I\ (/.� V, /�/lll;'I 'V,�/✓JY OATE � 3 A11EJ12 <br /> TNM,PR OR SNIP Y 7I011 BY �G1� PATE / FINAL INSPECTEON BY DATE / I <br /> AODITIONALCOMMENT6' JM1 IS OW' AII['E' '. % T. y1.e <br /> ACCOUNTING ONLY, NDS FACS <br /> R CODE f1Q 01FD AMOUN7 RBIB ITTO CUEC AAA BEC BT DATE SA I PERMIT NUMBER TN"CB P <br /> Pub.Haehh Sm.-Ewro-174(3196) -- <br />