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APPLICATION FOR LIQUID WASTE PERMIT <br /> ' -)"90 APPLICATION <br /> JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ON 31111,446 N.SAN JOAOUIN ST,STOCKTON,CA 56201.0 <br /> (2 911 4 614420 <br /> ' NONREFUNDABLE PERMIT EXPIRES I TEAR FROM OATS ISSUED <br /> jFsAYu Y Triplicate) <br /> Application is hereby made to the San Joaeuln County for a panslt to ctnstrvct ard/or Install the work described. This application <br /> is eade in carylianc,with San Jopuln Canty Davelazaant Title, Chapter 9-1110.3 and the Standards of San Joa,uln Canty Public Nsslth <br /> Services, Environmental Health Division. 111'nJ� 'I�'t. <br /> Jab Address/.r'AJPNN 1 O 2- �•'T-TyrTrl rTy/ IL,�• Clty P ck11°(�9rlaoplze <br /> Oaaer'S x.ae(TAT .7t�2t,').D 1wd1;. Ad*... �12 Sn. �rar_3'iclM.el t�D [�-?. -opl Ph mje <br /> ' Contractor l/G/Vt.y/I Address Liel Ph" <br /> Sub Contractor Address Lie/ Phone <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPAUGADDITION 1 I DESTRUCTION I 1 PENC TEST(,l 1 I Naw sa.F <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) <br /> ' _ _ <br /> Installation will serve: Residem* Coaserciel L//' WI Use ApWaba f <br /> Other <br /> Nurber of Tiring tnIt . Mostar of bdroaar INebar of aVt.ywr I� -3f) ��r L <br /> Charas tar of sell to • depth of 3 feet, Pit/Soup Soil Chsra.tari Water Table Dept ' <br /> SEPTIC TANWOREASE TMP 0 type/Mfp EYv7i ST Capscl ty Ne. CwparteannI, <br /> PRO TAFATMENT PLANT L I Dlet.. to near..t: Veil RA71ir foudatlon Property line <br /> LIFT STATIM IT Size_Type of Pulp_Sand 011 Sep,-.tor (.1a.ed systM) <br /> IEACHIN4 UNE tl• No. S length of IIm, Distance to N....at Met I-O- Favdstlon252 Property Lin IDD r <br /> FILTER BED (I Width= Lerpth_Depth Well FoudationProperty LIne <br /> U <br /> MOUNDED Width LmOth_Depth_ Well Foundation— Y <br /> Proper[ Lim <br /> SEEPAGE PITS ❑ Depth_Size_Timber_ • Veil_ Fou dation_Property Line_ <br /> ' SUMPS U Width_lxpth_Depths • Wall—FaMatlan_ Property LineJ� <br /> U Width_length_Depth_ Wail . <br /> DISPOSAL PONDS Foundation Property tire <br /> I hereby certify that 1 have prepared this applltstton anal that the work will a alma fn a.cordgee with San Jop.rin County Orel... <br /> W State Laws, and Rules and R.gulations of the San Joafuln Canty. Nose avrr or licensed agent's signature certifies the following <br /> ' : •'1 certify that in the perforNen+ce of the Mark for which this Fannie is Issued, 1 shell not splay any person In such •Manner as <br /> to become object to workaan's casctsation len of Gll lornl a.• Contractor's Win, or sub-contracting signature certifies the <br /> following: a[ certify that In the perfareance of the work for Mich this panni[ Is Issued, i Melt aploy,persons subject to worker's <br /> coepensa4lon [.We of California.. <br /> TM WE.nt' Ones! <br /> o R H Be Irl.Mnw Ian N raednl ispatiaa. Caplet.drwing below. f-��.s� _� [}Sl Ones! U <br /> K s .l Title: Ir l;ft JN- Date: <br /> PLOT PN (Draw to Seat,) Sule • to <br /> 1. Tissues of streets or resds nearest to or batsding the property. A. Location of hose swage disposal systes or <br /> 2. Outtine of the property, with dlneneions and North direction. proposed expansion of s.we,e disposal ayatess. <br /> ' 3. Oleensioed outlines end location of all *Xfsti N Well proposed 5. Location of wile within radius of 150 ft. on <br /> structures, Including covered area. such as petits, driveways, the property or adjoining property. <br /> and wal T. <br /> ' <br /> T <br /> ' <br /> oFFK <br /> eih <br /> n Y r N? <br /> - R <br /> 1 <br /> UG 18 199 <br /> „I Jul <br /> Nf ENT � <br /> FOR DEPARTMENT USE ONLY ' T <br /> i <br /> Application Accepted by i- -cG.lw< � �/s� Data! Meer <br /> lent, Pit or Suip Inspection by Date / / Final Inspection by L•/[tit-,SJi-ice Data/[7 /u/Qh <br /> ' Additional Contents: 40 6l�� •'••`t-.� W/•- ,moi a- <br /> ACCOUNTING ONLY: AID# FACT <br /> ' PE COOP FEE INTO AYOVN!REMITTED CNECC SN RECEIVED IT BATE SRI PERMIT NUMBER INVOICE f <br /> li4,CD <br /> 95cC3 <br />