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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)448-3420 <br /> 11011 REFUNDAOEE PERRM E%P1RES 1 YEAR FRO y BATE($SUED <br /> Mentp ce)•TrIRRaW <br /> APRATIOH LT NOIESr MADE TO THE SAN JOAWIN COUH"FOR A PEF"T TO CONBRRJCT AHDOR MS L TIE WORK DESCRBEO.TME APPLICATION IE MADE W COMPLIANCE WITH SAN <br /> IC <br /> JOAQU IN COUNIy OEWLDPMENT TITLE.CHAPTER S-1110.2 AND TINE STANDARDS OF BAN JOAOUIN CDVNry PUKJC HEALTH SEANCES. E�AL HEALTH DMSION. _,D <br /> JOS ADDREaS�OR A,"NY « 'l3� 1 C'SctyC, em L.C74�<C O VCJ�f IDT SIZE R <br /> OWNER's NAME 3 \"A'At/t�S'CV _ ADDIIEso <br /> t3 4 e� FtcT c-Q MWNE Zz -74,T? <br /> ,f <br /> 00 c) LO/ ��.71 I PHONE Lb— 07 <br /> COHIlUCTOR <br /> SO I.LS ADDRESS <br /> atJB CONTRACTOR <br /> ADDRESS 11CF �1OE <br /> TYPs OF f[RTN%WORK: NEW INSTALLATION❑ RVAIRIAbd TION I maTRULnON Q <br /> /SIC T1511.1I N7W MARY <br /> IND SEPTIC SYSTEM➢ ATTED IF PJVUC SEWER 1{AVARTf <br /> ABLE WIN 200 RET OF SU{DING.) <br /> ( <br /> [R <br /> AFpMSow I� <br /> INSTALLATION WILL SONE RESIDENCE COMMENCIAL Q OTHER❑ <br /> NLIAUR Of ErANO ESRTS: I RtmaI OP Elamous RUNNER OF lPAROYQS: <br /> CHARACTER OF SOIL TO A DEPTH OF J PUT' PRJSUMP SNL CHARACTER- (f WATER TABLE DEPTN <br /> SVTIC TANIUNRA{E TRAP ❑T1fPFlAiG <br /> CAPACrrY No.COMPAiMAEMi <br /> PKO TRSATMENT MANT❑ DISTANCE TO NfA1V 1T: WE71 <br /> FOUNDATON PORRrY UM <br /> UFT STATION❑ SIZE TYR OF FRRAP SAND OIL SEPARATOR(ENCLOSED SYffTEMI — 1 j U I <br /> dSTANC:£TO NEAFEST:W[i1_ (�FOUNOATON 7� MIOTCRTY EINE <br /> LEACNNO UNC NO.S LENOTH OF UNES L I] !7 <br /> u❑CT}` �z1 _ <br /> I" <br /> FILTER SSD WOTH LENGTH--DEPTH DISTANCE TO NEAREST:WELL hI/DATION FpppER1Y <br /> UOUNpFWIDTH LENGTH bFPTN dSTA}C[TDNEAAKT;WELL FOUNDA7IDN MORN UNE <br /> — w'i <br /> SEIPAOf FIT{ S�_3rQ' NSR_r DSTA [TO NEA : O—/ ""'N-1lP PROPERTY 1E5^ 1a � <br /> i11oS ❑WIDTH 120TH-DO" DISTANCE TO NEAREST:WELL—FOUNDATION PROPERTY IJNE <br /> q{P0{AL FONDS [3 WDH LENGTH DEPTH DISTANETONEAEST:WTL_ FOUNDATION FROM"UN � <br /> , <br /> S. <br /> AM <br /> 1 HERESY COREY THAT 1 HAVE PREPARED TMS APPUCATON ANG THAT THE WORK WILL SE DONE N ACCORDANCE WrTN AAN JOAOVIN COVNTY O!'OPOEtANCK E� �fORrY1/1CN <br /> AND R[011LA71DJNO OF THE SAN JOAOIJN COUNTY.HOME OWNER OR LICENSED AOEIITY SIONATUFE CORIREI TIE'W LLOLYIIIOt'ICOIRFY CONTRACTOR'S ISBpp OR <br /> THIS PER NOT IS ISSUED.1 SHALL HOT OWL*y AW ANON M SUCH A MANNER AS TO BECOME SUBJECT TO NORICNWI'S COMPfNSATON IS�S�AVA OF C 1 SOY PERSONS SUBJECT TO <br /> SUB-CONTAACT1q epRA�U CERTPES THE FOLLC~:'1 CflITIFY THAT M THE PETEONS IS A OF NNE WORIFOR FOA WHICOUNUI NSHISA S_CMAKM ARAVANO BELOW_ <br /> VAIKMAN'S COMpdpsAT(10J{!LAWS OF C 7M AM'UCART MUST CALL K IOtR{M ADVANCE FOR ASL RSOIB{m <br /> \ _ <br /> ..�„� c TRL2. <br /> BONED% <br /> ROT RAN(DRAW TO SCA-E)=ALE—.—*1° <br /> 4.LOCATION OF HOUSE SEWAGE dYOSAL SYSTEM OR PPOFOSED <br /> 1.NARES OF STREETS OR ROADS NEAREST TO OR BOUND"'THE PROPERTY' EXPANSION OF SEWAGE DISPO{AL SYSTUMS. <br /> 3,OUTLINE OP THE PROPERTY,WITH DMENSIONS AND NORTH DIRECTION. s-LOCATION OF WELJ.1 WITIfH RADIUS OF ORC NUNORED FIFTY FT.ON <br /> 7. D1MEHSONW OVMNES AND LOCATION OF ALL EXISTMO AND PROPOSED SRKJCTURES. THE MOPETITY OR ADJOINING P110PORTY. <br /> GKLUDrNG COVERED ATLAS SUCK AS PANTOS.DRVEWAYS•AND WALKA. -� ... .. .. ........ <br /> \ — .ELv <br /> s <br /> ........ . . <br /> ....... <br /> :Ll <br /> ........... <br /> 5 tR1 <br /> K.y.. .:............ <br /> 'MAY : 1 <br /> 0AFSFOR DVAPTMERT we oNLY <br /> DATE: S <br /> _A: �t <br /> APRJCATON ACCEPTED By „'-�S-PfATE. l r <br /> / DATE INK INSPECTIONaV <br /> TANK�OR—---14S - . <br /> ADDITIONAL COMME'1TS• 7 <br /> ACCOURI9Kf ONLY: i FAL! <br /> I/TVOJOE <br /> RE CODE FR INFO AMOUNT RENSTTW CNBC A{H FIBCEIVm EY DATE am J PiToArr Pl a 3 <br /> DID n o t f3 L <br /> PLO.FLSGM SON.-EnAro.174(3M6) <br />