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APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICESENVIRONMENTAL HEALTH DIVISIONcar <br />P.O. 80%:868, 446 N. SAN JOAQUIN ST., 8TOCKTON, CA 96201.0385 <br />q Str^� (209) 458.3420 <br />ON -REFUNDABLE PERMIT % RE$ I YEAR FROM DATE ISSUEDLJ�� <br />iCampl•b 10 it <br />}Wool <br />A ca n Is he eby made to the Sen Josqu aunty for a permit to construct and/or Install the work described. This application <br />is n compile ce with Sen Joaquin County Deve to ter 9-1110.3 and the Standards of San Joaquin County Public Health <br />Service$, Envir tat Health Division. p per( <br />Jab Address/or ppAPN��II__ �� E v�� "" FAQ S �' City L� Lot SI- <br />-owner's Name FAMI fh(f ut*l Address `% D F• 0-11410'&11A �2. LUV DFA 95236 Phone �Z <br />contractorSl&UPLIED EAIC-�It4W, Mei Address gOL15 CO'�-0NY�Do A -VE OcN Phonagy3 �O7i/ <br />Sub Contractor_ i Address 'LIcN Pho <br />TYPE OF SEPTIC WORK: )NEW INSTALLATION I I REPAIRIADDITION I I DESTRUCTION I I PERC TESTIeI Ul!jl•w u <br />(NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) J_ _ 3 C <br />fk- <br />lalm4 Use ApplMelka N <br />installation will serve: Reeidence_ Cbwmrclal_ Other_ _ -J <br />Number of living unit•tNumber of bed_ r— oomal 11 C G character—Depth__'� <br />SEPTIC TAI1 O 1 compartments <br />ROBERT FREEMAN <br />PKG TREAT JEANNE ZOLEZZI 90-64411211 operty floe <br />PH. E. <br />"87-2223HIGHWAY — ,^ ae 04724267 <br />19704 E. HIGHWAY 26 ,,,. <br />TEACHING � -SLIIN/DEN,, CAy�952339''.j. a •roperty Lirvr! �„ <br />FILTER DED PAY TOTNE�nn.IrXAGt'611L-'1{'"$' ropertyLine__tk) <br />ORDER OF j' rt LIna <br />MOUNDED l OLLA'RS ops Y <br />SEEPAGE PI 3 �operty — <br />f ,,. Line <br />FA MERS & roperty Llna_ <br />-MSUMP1 BKNSDlspaset P ANLne <br />x. <br />t hereby c - in county Or no <br />and Stated MEMO Ila Ctifles the folio -.1I <br />"1 carni 1; L 2 l.)mOB44 L1:0 10 L Ole 7 �,e•tature cerrti} es the - <br />to becomei i <br />following: -• - mfr wIcn iota permit Is issued, 1 shall employ person subject to worklmm� <br />compensation laws of California." <br />The oppll•ant mustyB 24 haute In adva/n/n�cce�foi di rqulyd kwpsetIOAL COMP <br />lete drawing below. q ,, 1 <br />Signed K f \ rte✓ • Title: r{,� T Date: <br />PLOT PLAN (Draw to Scale) Scale " to <br />1. Names of streets or roads nearest to or bonding the property. 4. Location of house sewage disposal system or <br />2. Outline o}.the property, with dlalenel me and North direction. proposed expansion of sewage disposal systems. <br />3. Dimensioned outlines and location of at( existing and proposed <br />5• theatro rt orion of ladjolning pros within 1perty. us of 150 ft. ons <br />structures, Including covered areas such as patios, driveways, P Pe Y I <br />and walks. r <br />e <br />o rp <br />0)3" - <br />.1 iC <br />(e.In O <br />Z <br />FOR DEPARTMENT USE ONLY <br />Application Accepted by Date: <br />Tank, Pit or Sump Inspection(�by Date' '/ / Final Inspection by <br />Additional Comments., <br />Ptxkt.,. <br />ACCOUNTING ONLY: AID# FAC# ."— ""^"' —I <br />PE CODE FEE INFO AMOUNT REMITTED KNI ASH RECEIVED BY DATE SR I PERMIT NUMBER INVOICE <br />222 7 <br />1:7-7 Y <br />% e rl �. <br />�� �1 / c 5co.+ ssa• -a 3 <br />Per"c vYvru o�7/I /inS/><P (�t % �. ih Sr�x � o .sae ---3. )0 <br />a /0�.y Q' 07 . S y 3 . / .�c� . �: uJ"A' uPn" (n <br />�vm res. rU <br />hu )sloe cI % -I(& " " %a <br />k- <br />Ak <br />qv <br />S <br />p <br />o rp <br />0)3" - <br />.1 iC <br />(e.In O <br />Z <br />FOR DEPARTMENT USE ONLY <br />Application Accepted by Date: <br />Tank, Pit or Sump Inspection(�by Date' '/ / Final Inspection by <br />Additional Comments., <br />Ptxkt.,. <br />ACCOUNTING ONLY: AID# FAC# ."— ""^"' —I <br />PE CODE FEE INFO AMOUNT REMITTED KNI ASH RECEIVED BY DATE SR I PERMIT NUMBER INVOICE <br />222 7 <br />1:7-7 Y <br />% e rl �. <br />�� �1 / c 5co.+ ssa• -a 3 <br />Per"c vYvru o�7/I /inS/><P (�t % �. ih Sr�x � o .sae ---3. )0 <br />a /0�.y Q' 07 . S y 3 . / .�c� . �: uJ"A' uPn" (n <br />�vm res. rU <br />hu )sloe cI % -I(& " " %a <br />