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APPLICATION FOR 11QUIO WASTE PERMIT `v4 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O.BOX 388,445 N.SAN JOAQUIN ST.,STOCKTON,CA 95201413BO (205)4683420 I NOIFREFUNOARt PERMIT EXMRFFj 1 YEAR FNOM DATE 133UED IC4mokit.in TrylioW APPLICATION IS HEREBY MADE TO THE BAN JOAGUIN COUNTY FOR A PERMIT TO CONSTRUCT ANOVA NSTALL THE WORK DESCAN ED. THIS APPLICATION IS MADE N COMPLIANCE WFIDI SAN JOAOVIN COUNTY DEVLLOPMENT TILL CHAPTER&T 110.3 AND THE SSTANDARDSS Of SA JOAGUN CWNI'-Y PIIMIG HEALTH SERICFS.ENV1pNM HEALTH DIVISION, Jos ADDfiF55.01//LWPN1 lJ_ l n^ ,/(��✓71�T/I� CTTV��s ice"_ ERT STE OYVNER'B NAME Etf..�'3l .9 ADDRESS PHONE CONTRA TOR VVT�T.T� - L R ADORESR UCI�R10F4- '/ BUB COMRACTOR_ ADOINI LIC/ PHONE TNF OF BElTIO WORK NEW INSTALLATION❑ RFPARVADOITION DNTnUcT10N❑ NO SEPTIC SYSTEM PERATTED V PUBLIC SEWER IS AVAAASLE WrTWN Zoo FEJT OF BUILDING.) ——1.11 I 1 IIF:W MANY MIN{aPI I INSTALLATION WILL SYNF' RESIDENCE Ift COMMERCIAL 13OTHER❑ NRMBI OF LMNa U—..—I—Nua9R OF BEDROI7 c NUFISER OF WIPOIS S. ,v CHARACTER Of SOS TO A DEPTH OFFI-•3R FEET. PTISUMP SOIL CHARACTER. WATER TABIC DEPTH {pIC TAN[/pdABE TRAP y TY E,,,M CAPAcr NO.COMPARTIIEMTS ►KO TREATM[NT RLARANTIEA T 13 DISTANCE TO rTEST. WELL FOUNDATION rH AOPERTY I UFT STATION 0 W2E TYPC OF PUMP_SAND OIL SEPARATOR IENCLOSED SYSTFLI I �I U E"."No UNE ANO.LENGTH OF UNE,_ _x I DIOL AHC,,TD NEAREST:WELLIONyC PNO/FJRY LINE�_ ^�' MEW BED ❑WROTH LENGTH_ OE^PTH DISTANCE TO NEAREST'.WELL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTHDEPTH D,ANCF TO NEAR ST:WELLFOUNDATIONPROPERTY LINE S®D AE PETS XDEPTHout �NUMFE;=DISTANCE TO NEAREST:WELL-TOZATION_�POPURY UNE�',io:� SI.EA►t ❑WIDTH LENGTH__OEM UISTANCE TO NEAREST:WELL._FOUNDATION P90PERTI'UNE l DISPOSAL KORO, ❑WIDTH LENGTH _DEPTH DISTANCE TO NEATEST:WELL__FOUNDATION PIOPERFY UNF !L 1 HERS,CERTVY THAT t HAVE P11E►AfED THIS APPLICATION AND TEAT TIE WORK WILL SE DONE IN ACCORDANCE WTH;AN JOAGUN COUNTY ORDNANCE.AND STATE LAWS.AND MORES \) AND REGUTATONS OF THE SAN JOAOMN COV MY.HOME OVANER OA UCENBED AGENT.SIGIIATLNE CERTIFIES THE FCL DVANO:'I CERTFY THAT N THE MAHORMANCE OF Mf WEAK FOR WENCH THIS PLI IS ISSUED,I WLL WORKMANANOT EMPLOY ANY PERSON IN SUCH A MWHER AS TO BECOME SUBJECT TO S COMPENSATION LAWS OF CAUFDINA:CONTBACTOW11)MINS OR SUBCONTRACTING SIGNAT UIE CER—Ife THE FOLLOWING:-I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 WALL EMPLOY PERSONS SUBJECT TO WOFECMAN'(B//CO/IPE-NSATION LAtVB OFCMIFOIN E AFPUC AM MWT CALL 24 HG—IN ADVANCE AOR ALL EEEOU0kD INSFECTEONB_ COMPLETE DRAWING SELDW. SHINED A J / /1.Nn A _ J TRIS: i ./A�L/1 DATE: ROT PLAN IDRAW TO SCALF�SCALE 1.NAMES OF STREETS OR ROADS NEAREST TO OR SOUND"THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM DR PROPOSED 2.OUTLIIE OF THE PROPU—.WITH DIMENSONS AND NORTH DIRECTION. EXPANiIUN OF SEWAGE MM BAI SYST WS. ].OIMENBIONED OUTUNEB AND LOCATION OF ALL EXISTING AND PRDFOSED STRUCTURM S.LOCATION OF WELLS WIMHN RADIUS OF ONE HUNDRED FIFTY FT.ON IWLLAING COVERED MEAS SUCH AS PATIOS,OHIVEWAAYS.AND WALX9. THE PROPERTY 00 AAAoJOIMNG PROPERTY. .. .. .. SSSS •: .I ..• I ........^+y .�..-: :.••...• - SSSS.._ _.. .. :SSSS i ..<....: ..._:....... .:. ... ..._........;. - . ,SSSS . SSSS.:. ... ..:__ _. ... :. _ . _.. PAYMENT 1 -C.._,... . _...: ..._.. ;SSSS... : :.....'..' :•• SSSS.._ ..., SSSS - -- NOV- 8 moi._ . l :1:NFigITN atR'vT�h . . ' e ....... 4r hd�Ljj�f Y.r,AI. 66, � ... .... . SSSS. - `SSSS..: : SSSS:.. SSSS.. SSSS ..•..SSSS _.. / I SSSS..,. .__SSSS. FON DEPARTMENT W[ONLY "A"..ACCEPTED S., C DATE: AREA' J i TAMC PIT OR-.11.-BV • � GATE / FNAB INSPECTION ST CITE��r r�� ADDITIONAL COMW-NTS: III KCOUTFTMO ONLY: AIOM FAC• P•—DE FR BIRO AMOUNT ft gTffD CHFC MN RELIEVEDBY DATE .YOKEF oa3c I I