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APPLICATION FOR Uawo WASTE PERMIT PAYMEN7Q <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES C L�'�9`� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 DEC 31 1998 <br /> (209)468-3420 <br /> NOIFREFDNDABLE PERM"EXPIRES I YEAR FROM DATE ISSUED EN SAD� �TS�tjyl�Es <br /> IC[MPIEtB Is TII,Ratd AL+iEAITy�(LO�,,"` <br /> AIiTJ 1101,114 HEREBY MADE TO THE SAN JOAOUIH COUNTY FOR A Ff RLST TO CONSTRUCT ANOIOR INSTALL THE WORK MUCI[BED. THIS APPLICATION M MADE A CtlIRPseIpW.STH MN <br /> JOAMIN HEAL <br /> N. <br /> JOB AD0ftSSBNN, Nf 1 Z V4 0 1 EN 9•1110.7 AND�ME B1TNOARDB MLS^ OIAN CODUT +BLICCITY TN�r ✓l.0 AL HEALTH DIVMIOOT M2E�� <br /> OWTER•S NAMF J��✓\ CJW�• �f,(vl ((Illi/"`Y f`ADD`/IREBJ//I/lR 2C./`JV J n+oN[ 2.23 7 <br /> COMIIACTOL\ J �`� ADOKBF `� L.�FIF.� �� "' UCS PNONE �� <br /> SUS COHTRACTOR ADOM" LICE I1MfE <br /> TYPE OF SEPTIC MOR[: NEW dSTALLATION❑ RETAWADOtTlO ODBTRUCTTOM 13IND SE►TIC SYSTEM PUPWIITEO B kXWJC BEWER IS AVAILABLE WTIH"2OOFTrTOfSlkLDII4O,I FB1c TE+TW t 1 IIIW MANY <br /> APFS�SSR I� <br /> INSTALLATION WILLSOIVIR: RESIDFNILE LULRAERCIAI❑ OTHER❑ <br /> NUP01M OP UNNO UNITS: MIMTI#M B 1100M8// NUN�91 M PIROYQB: / De (r <br /> CHARACTER Of SOQ 70 A DEPFN OF 7 fEtri C'iAt� /TT(BIMP tort CHARACTER WATFR TABLE DEPTH l <br /> SmW TANKInKFASE IIIA/ ❑TY'PFJLTI'O CAPACTTY NO.COMPAR"AMTS <br /> -0■PWATR41T KAM❑ ONTMC[TO NEARLTIT: Y u FOUNDATION N FrrY LIE <br /> LIST STATION 0SIZE TM of PUMP SAND OIL"PMATOR(ENCLOSED SYSTEM) 36G, <br /> J C <br /> LEACHING, <br /> UNE `yJ'NO.\IENOTH M LINEB�`y✓ /, _ DIST NICE TO NEJ1lRST:W[ll B/ Q FOUNDATION 7Q _ Pf10PERTV UE <br /> RLTM1 SW L]WAOTH LENGTH am. DISTANCE TO NEATEST:WELLFOLOA]ATION FIIOPEATY LINE <br /> NIOUNDED ❑WIDTH LENGTH DEPRH DISTANCE TO NEMER'WELL <br /> FOUNDATION _PROPERY UNv <br /> SsvAOFITS E4dSTNrCE TO NNEETI / O <br /> ��O MUNDATION� /t <br /> SIMM ///❑WRTTH LEMTH _D07H DISTANCE TO NEAREST:WILL_—FOUNDATION VMPCRTV LINE <br /> dS►OIAL PONOS ❑WMTH LENGTH DEPTH DISTANCE TO NEAREST:W4LL__FOUNDATION PROPfiRY UNE <br /> 1 NEWSY CERTIFY THAT P HAVE HIS APPLICATI N ANO THAT THE WOFK WILL BE DONE N ACCOMp f WITH'JAN JOAQUIN COUNTY OIOINANCES AND STATE LAWS.AIM 1BAEB <br /> ANO PEO AOUW NTY.HOME EROLILICLYBEDAOEM•S ISONARIPE CPRIPESTM FOLLO"APM IOORffYTHAT WTLIFFFF0FSAN/CE MTNEWOFK PONMAIICH <br /> THIS;PPIT <br /> NOT ELLO ANY PERSO OWN A MAVNER M TO[[COM[WSJECT TO WOISLMAY.Y COMFEN[ATION LAWN OF CALLIOHML• CONTRACTOR'S WEND OR <br /> SUWCONC STN FOLLDLMN :'CWtIFY THAT N THE PFFIPOP"ANCE OF THE VPGM FWNWHICH THIS POWIT.IS WoUED.I MINI EMPLOYPERSON SUBJECT TO <br /> WOEBLYA1WIA,• Tl AIeI FAIL D!IOLIu M ADVANCE 1'011 AU.11BOIMIED BNFg'TOMS. COSIL[TE DRIIWNIO Bl7OLV. <br /> I <br /> FDX 1 "TIE <br /> PLOT PLAN DRAW TO SCALE)SCALE _•to <br /> 1. NAME[OF f1'"IMOR 110 BT TD OR SOVNDINO THE PROPERTY. A.LOCATION OF HOUSE WWAGE DISPOSAL SYSR TEM OFWPDED <br /> 2OUTLINE OF TNT PIIDPEIRY.MRH DMINSIONS AND NORFN dPIECRIOH. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> O.. ONNNSPO ED OUTLIES ANSI LOCATION OF ALL EXISTNO AND FFIOPOSED STIIICTUfW e. E.LOCATION OF WELLS WTTHH PAM"OF DIE HUNDRED RFTY FT.ON <br /> SCLUDNG COVETED AREAS SUCH AS PATIOS,ONVLWAYS•AND WALKS. THE PRORRIY 011 AD.IOONW NIDIERTY. <br /> .. _ ... <br /> jSIA _ <br /> N.: - <br /> . ... <br /> .. ..... .. <br /> _...._.. - rY. <br /> . <br /> ... E <br /> I <br /> a' <br /> ... .. ...:............:.... <br /> ..._.......r......'.. <br /> • . a <br /> Ems: <br /> :..1'..:. .. ...... <br /> oI(, <br /> AF`FWATION ACCEPIID BY <br /> TAW,6,OR WLIF NSPECTIDIN BV DATE FINAL INSPECTION BY DATE <br /> ADDITIONAL COLUAMTS: <br /> A <br /> C <br /> C <br /> O <br /> U <br /> NT <br /> " <br /> ', <br /> ONLY! A D# FACT <br /> M CODE FR AMGMI RXINITED CIRC ASN Ma YVIM■Y DATE SR I PNMT MULMM1 INVOICE S <br /> Pub.Heath SerY.•E.IrvIrD.174(3/%) <br />