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f v' APPLICATION FOR UOUID WASTE PERMIT (P <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH 4MSION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> ROWN RDABLE PERMIT EXPIRES 1 YEAH FROM DATES EXPIRED 0 <br /> IGgMtf in TrIPAITsu) <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PE IT TO CONSTRUCT AND/OR INSTALLTHE WOW DESCRIBED.THIS APPUCATMIN IS MADE IN COMPLIANCE WITH BAN <br /> JOAOM COUNTY DEVELOPMENT TTT1F.CHAPTER 9-1 T 1 .3 AND THE STANDARDS OF BAN JOAOUN COUNTY PUBLIC HEALTH SERVICES,ENNVVIRIN&E/ITAL HEALTH DIISION. <br /> JOB ADORESSfOR ARJE Q' ,�U /CITY 2> yc.4C ZUaAj LOT SIZE <br /> N <br /> OWNER'S HAE DRESS C J./L C �er�E PHONE g <br /> CONTRACTOR ADOIE66 LIC/ PHONE <br /> SUBCONTRACTOR AOOIIE8a LACI PHONE <br /> TYPE OF$EPTIC WORK: NEW INSTALLATION❑ REPANAAO(RION❑ DUTRVC <br /> ONO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE NRTHN 200 FEET OF BUILDING.) P/tG T2fTb1 l I HOW MANY <br /> APPMFfeII <br /> INSTALLATION WILL SERE: RESIDENCE❑ COMMERCIAL❑ OTHER❑ <br /> NU MSER OF UVRNG UNITS; NUMBER OF BEDROOMS: NU IM OF EMPLOYERS: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: Prr/SUMP SON.CHARACTER: WATER TABLE DEPTH <br /> SEPTIC TANR/O(LASS TRA► ❑TYFEJMFO CAPACITY NO.COMPARTMENTS <br /> RRO TREATMENT PLANT 13 DISTANCE TO NEAIIEST: WELL FOUNDATION PROPERTY LINE <br /> LF ❑ <br /> T STATION s¢E TYPE OF PRIMP SAND ORL SEPARATOR IENCLOED SYSTEMA <br /> LEACHING LINE ❑ NO.S LENGTH OF LINES DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> RUTH BSD ❑YVIOTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> MOURDSD ❑WIDTH LENGTH DEPTH OISrAKE TO MEREST,WELL FOVNDATION PROPERTY UNE <br /> SEEPAGE RTS ❑DEPTH MZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> SUMPS ❑WDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL PONDS ❑WD7N LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> I HFRESY CERTTfY THAT 1 NAVE PREPARED THIS THAT APPLICATION AND HAT THE MEW WILL BE DONE IN ACCORDANCE WITH SAN JOAOLIIN COUNTY ORDINANCES AND STATE LAIMS,AND ARES <br /> AND REOULATIONS OF THE SAN JOAOUH COUNrY.HOME OWNER ORUCENSED AOEHT'S AGNATLNE CERTRES THE FOLLOWNG:'ICERTIFY THAT N TNEVEN ORMAICE OF THEWOIK FOR WHICH <br /> TWO PERMIT IS ISHED,1 SHALL NOT EMPLOY ANY PERSON N SUCH A MANNER AB TO BECOME SUSJECT 70 WOIKBEAMS COMPENSATION LAWS OF CALIFORNIA.*CONTRACTORUR NIMH OR <br /> SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT U ISSUED.1$HAL EMPLOY PERSONS SUIMCT TO <br /> WORKMANS COM=LAWSFORNIAL' THE AFFUC RAUST CALL 24 MOURNS IN ADVANCE FOR ALL REQUIRED INSPWTIONS. COMPLETE DRAWING BELOW. <br /> EORED x TRUE: C­L.� _ DATE- <br /> ROT PL.41 RAW TO SCALE SCALE •ro <br /> 1.NAMEB OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. 4,LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. AN <br /> OUTLINE OF THE PROPERTY.WITH DANTHRONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3.DIMENSIONED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION OF WELL RIS WITHIN RADOF ONE HUNDRED FIFTY FT.ON <br /> OKXLWM COVE®AREAS OWN AS PATIOS,DRIVEWAYS,AID WAILS. THE PROPERTY OR ADJOINING PROPERTY. <br /> .... ... .... ......r. ...,.. <br /> ....w.. ....,-, .. <br /> got:e <br /> ...... ...... ... ........... .i ... L.,... <br /> .. <.....`"... ... �.1 <br /> jr, <br /> ... <br /> Ehr� err `E <br /> ....... <br /> ..... <br /> snn lOAG�IM c iu .I� <br /> ...... <br /> .......... <br /> ....:... <br /> w. <br /> __.. . ... .. .... .....__.._...._. _......__...... ....... .. .. <br /> r`yjn/�AL�/[/��/��] [�/•]��{/}�J <br /> A/TLICATgN ACCEPTED BY fgJVH`F/'T/� \!1 ` ` OATEN / AREA: <br /> TAX,PIT OR SUMP INSPECTION BV DATE I I FINAL INSPECTION 0 _ _ i DATE <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING ONLY: RED/ FM! <br /> FE COOS FEE INTO AMOUNT REAITED ITEC ICASH IECEVED■Y DATE N 10000117 NUMBER INVOICE f <br /> 5- <br /> Pub, <br /> PUD.HsatlSRY-Envlro.174(3/96) U <br /> /" _ SE2D Q t <br /> 4E k-61 <br /> 1 6_ <br />