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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O, BOX 388, 445 N. SAN JOAQUIN ST., STOCKTON, CA 95201.0388 <br /> (209) 468.3420 <br /> NOW-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IComplata in Trplieata) <br /> APPLICATION IS HEREBY M( E TO THE SANJOAQUIN COUNTY FOR A PERMIT 70 CONSTRUCT ANWOR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. ,/ <br /> JOB ADDRESSIOR{A{PNI ¢ q q _ donde -0! - �f• CITY Y t CJ�TJ LOT SIZE WCC D <br /> OWNER'SNAME J?eO& Y GrArcf05 ADDRESS W6 <br /> C-W'7 m PHONEqj( <br /> — d7 <br /> �/VX /�O7 <br /> CONTRACTOR J Al7ORL55 f JI)IrI BIER I yX4H.NE <br /> SUB CONTRACTOR AULIMSS UCf PHONE <br /> TYPE OF SEPTIC WORK: NEIN INSTALLATION REPAIRADDITION ❑ DESTRUCTION ❑ <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET Of BUILDING.} PEFIC TEST hI I I HOW MANY <br /> ApoFlwtlon <br /> INSTALLATION WILL SERVE RESIDENCE COMMERCIAL❑ OTHER 11 <br /> NI,MBER OF LIVING UNITS:_L NtWBF31 OF BEDROOM - � NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET; n FIT/SUM P SOL CHARACTER: WATER TABLE DEPTH <br /> SEPTIC TANKfOREASE TRAP V(-KJMFG , G/e- // CAPACITY I1 6 dO 'A NO.COMPARTMENTS <br /> PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION MPERTY LINE <br /> 11FT STATION❑ SIZE TYPE OF PUMPV /�SAND OIL SEPARATOR(ENCLOSED SYSTEM( <br /> LEACHING UNE NO.&LENGTH OF LINES <br /> Fl- <br /> LEACHING TO NEAREST;WELLI FOUNDATION- ,.PROPERTY LINE_ <br /> I -_ <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIOTH LENGTH DEPTH DISTANCE TO NEAREST;WELL FOUNDATION PROPERTY LINE <br /> SE"ePAGE PVT& ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> SUMPS 0 WID i M LENGTH DEPTH DISTANCE TO NEAREST;WELL FOUNDATION PROPERTY LINE <br /> DISPOSAL PONOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 H�VE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCEWEER SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES W <br /> AND REGOLATIONS - THEI NJOAGWN COUNTY.HOME OWNER OR LICENSED AGENT'6SIGNATURE CERTIFIES THE FOLLOWING;'ICERTIFY THAT IN THE PERFORMANCE OFTHE WORK FOR WHICH <br /> THIS PERWT IS ISSUED,t i,HAtL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> SUBCONTRACT"ING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO O� <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. <br /> SIGNED% "^`4/ i 1'L_I I TILE:__ _ l,/ yv �` DATE: Cl— <br /> PLOT PIAN{DRAW TO SCALE]SCALE 'to O <br /> 1. NAMES OF STREET S OR ROADS NEAREST TO OR SOUNDING THE PROPERTY, 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE Of THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. O <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PHOP£RTY OR ADJOINING PfWPERTY. <br /> �. <br /> V <br /> Q <br /> � bo <br /> h r)R � <br />