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APPLICATION FOR LIQUID WASTE PERMIT SAN•JOAQUIN COUNTY PUBLIC HEALTH SERVICES ' ENVIRONMENTAL HEALTH DIVISION P.O.BOX 382,445 N.SAN JOAQUIN ST, STOCXTON,CA 9620MBI (20S)481.3420 X0*RffVXQAftE PERMIT EXPIRES l YEAR FROM DATE lig LTO MAE*ISM IN Trlpks%) APPLICATION 1S HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PEFSAIT TO CONSTRUCT ANDiOR INSTALL THE WORK DESCNSSEO, TWO APR/CATION IS MADE W COMPLIANCE WRN SAN JOAQUIN COUNTY p`VEIDPMENT TR CHAPTER 8-11 10,3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH�SER�VICEII,EENNvwjokMENTAL HEALTH OMNON. JOS ADDR[SWR APH/_ L CRY 1 AL'QAAIS _LOT S Q Q 'e..• OVMIEKS NAMi� ADDREYS U , PP1ON[v 1_ IOP II CONTRACTOR ADDPEp LID/� SVS CONTRACTORL ADORE" UC/ PHONE Tvm OF*wnC INORK: N!W SYSTALLAnON L] /NJi ADDITIOw D[S711mmio❑ (NO SEPTIC SYSTEM PEFSAITTED IF PUELC SEWER 18 AVAILABLE VVPTHN 200 FEET OF BIAUI04-1 P7•IC TSSTIFI I 1►IOW MANY APLMSSan S INSTAALATWN WILL SUM: NESID NCE* COMMEYLi AL❑�/VL OTHER Q NUPA 6 OF LFANG UNITS: NUi41 OF EMPLOYEES; CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PR)SU 501-CHARACTER: WATER TABLE DEPTH T rwAr OTVPEITAFO� CAPACITY No.coMPIITTM[NTE PKG PLANT❑ DISTANCE TO NUJIEST: WELL Sb+ FOUNDATION0- - RMPIP.TY UNE ,+ LIFT STATION O SIZE TYPE OF PUMP SAID OIL SEPARATOR(ENCLOSED SYSTEMI LEACHING LINK X NO.A LJ716TH OF LINES \� — C L DISTANCE TO NEAREST;WFLL_- FOUf OAT10N �,�_+f PROPERTY LIE .l FILTH(EM ❑WDTH LENGTH—OEPTN DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LSE MOUNDED ❑YMOTH_T LE NOTN�__OEITIPDISTANCE TO NEANEST;WELL FOLINDAT)ON FgKwENTY LINE �— SWABS PRS DEPTH a-s SUE WJ MEFI--L _DISTANCE TO NEILEST:WEU 1 n n •r FOUNDATION=_MgPERTY LI SUMPS ❑VViDTH LENGTH DEPTH INSTANCE TO NEAREST;WFILL FOUNDATION PNLOPFJITY UWE ^� Ou"m PONOS ❑VAUT14 LENGTH DEPTH DISTANCE t0 NEAREST:VAELL _FOUNDATION PPIOPERTI'LIE 1 HEREBY CERTIFY THAT 1 HAVE PREPAREO THIS APPLICATION AND THAT THF.WORK WILL EE DONE IN ACCOPDANCE WrOI SAN JOAOM COUNTY ORDINANCES AND STAT[LAWS,AND ARLES AHO RF3ULATIONS OF THF SAN JOAOIANN COUNTY.HOME OWNER ON LICENSIEC AOENF'S OkINATUPE CERTIFIES THE POI.LOYMNO:'1 CERTIFYTKAT N THE PERFORMANCE OF THE WOMC Fort. THIS PU AST IB ISSUED,I SHALL NOT DIAPLOY ANY PEROON IN SUCH A MANNER AS TO BECOME SV0JECT TO WVFKPAAN'B COMPENSATION LAVA OF CAUPOFSVA.- CONTRACTOKS HSSNO OR (� SUN-CONrRACrINO SgNATUIE CERTIFIES THE FOLLOV.V16.7 CERTIFY THAT N THE MWOWIANCE Of THE WOW FDR WHICH THIS POWIT IS ISSUED,1 SHALL EAMLOY PERSONS BUBJECT TO WORKMAN'S COMFENBAT)ON LAWS Of CULk' THE APPLICANT MUST CALL 2E HOW IN AOVANICE POR ALL PEALMIIIE NNPlia"ONS. COMPLETE DIAVVINO BELOW, "NED X TITLE: TB PWT RAN LO AW TO KALE)SCALE 'u I.NAPLES OF STREETS OR ROAD&NEAREST TO OR BOUNCING THE PIIDPE ITY. A.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM 00 PROPOSED 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAW DISPOSAL RYTT919. �}KJ J.OMIENSIONEO OUTLINES AND LOCATION OF ALL EXISTNO AHO PROPOSED STRUCTUIEB, E.LOCATION OF WELLS WNH 4 PAORIS OF ONE HUFAED HFrY FT.ION INCLUDM COV Vlm APEAB SUCH AS PATIOS,OPUVEWAYS.AND WALXS. TTIE PROPERTY OR ADABN[I)P ROfVWV ... . ........ ...... I .. ...... :,. .. .. ................. .. ......... it ..i... I: • P .......v.. ...... :......:..... • .. ........... r '. .PAYMENT �`�^ ...... . '.-...;... ; RECEIVED .... .... . .i....... ........ :. ... MAR 1 SAN JOAQUIN couNTY . . ... .... .. _ ._ ........ ..............,....,........ ENV)RONMENTALHEALTH DIVI FOR DEPARTMENT USE ONLY t7 APPLICATION ACCEPrEC BY DATE: L 7 OR WHIP:NSPERgN 6YFWAL N8TEC7gN BY ADDITIONAL CO WWNT1: T ACCOW471MG ONLY: AW fAC1 IFODE FE[INFO AMOUNT FAMTYED N /CASH RLCNJV®SY DAT[ INVOIOE/ Z ( 000 q