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<br />SAN MAORI COUNTY PUBLIC HEALTH SERVICES
<br />APPLICATION FOR LIQUID WASTE PERMIT
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<br />(1‘4)\ \ ENVIRONMENTAL HEALTH DIVISION
<br />\ P.O. BOX 358, 445 N. SAN JOAQUIN ST., STOCKTON, GA 9520143388
<br />(209j 458-3420
<br />,2 (4 I' e...-__ Thu (41,1 5]-1101CREFUNDABLE puma EXPIRS 1 YEAR FROM BATE ISEIlla
<br />jetanplota in 1rip114.414)
<br />APPUCADON IS HEREBY MADE TO THE TAN JoADIAN cOUNTY FOR A PERMIT TO CONSTRuCT ANDDRINETTALL THE WORK Ofgcsimo, Dim AppL.CATION Di SIAM IN CDR. IM., WITH CAN JOAQUIN COLHTTY DEVELOPMF.NT TITLE CHAPTER 0, T T 10.3 AND THE STANDARDS OE SAN JOAouIN COUNTY %MX HEALTH SERVICES. ENVIRONMENTAL HEALTH DIVISION.
<br />JOB AbORESELOR MTH, Li +- ‘,. a v. & C 1 \Arx, Cir.-. 1.-6 r.....ALL (C.0.44145 LOI EME
<br />OWNER'S NAME KC.E.• SCA/%0E1 i ',. ist ADDRESS P. d' I 4 E:01( 3 1,. t14:4.vt4et.c.c, ci4 r 7573 Co pHoNE_VS— 3 2
<br />CONTMCTOR PC.A.Y.ViSA.N./ 5t.)1A_S ADDRESS (1, Don N. L.., i'd tser. won uvrigf3S*3 PEKIN'. ti4ir 7- 16411
<br />SUB cONTRACTOR ADDRESS LICE PfiONE
<br />TYPE OF SEPTIC WORK. NEW INSTAUATION 0 ASPARVADCETION lit DESTRUCTON JD
<br />3.10 SEPTIC SYSTEM PETRIrETFO SI PUBLIC SEWER IS AVAILABLE wrrmIN DID FEET OF BUILDING
<br />INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL t 0 OTHER a. 5c trr,00
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<br />WPC TO9Tht i TROVE MANY
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<br />CHARACTER OF SOIL TO
<br />SEPTIC TANKMREASE TRAP
<br />PRO TREATATEN? PLANT
<br />4107 STATION 0
<br />LEADMINO LINE
<br />RLEAllat OF SEDROONATi. NUNTSER OF FRIFOITEES:
<br />A DEprft OF
<br />0 DISTANCE
<br />SIZE
<br />3 FEET: Seowdis OTTAWA SON. CHARACTER• S N. 1A, RIQ. WATER TABLE DEPTH
<br />1YPET/Arc i..) rat, 1..., c4P4crry 3 goo NO, COMPARTMENTS
<br />TO CEMENT, WELL FOUNDATION PROPERTY UNE
<br />SAND OIL SEPARATOR °ENCLOSED SYSTEM )
<br />DISTANCE TO NEAREST: WELL TR0pERTY uNE Ill NO. 4 LENGTH PUMP OF 7.INESOF FOUNDADOIN
<br />FILTER SIM 0 WIDTH LENNTH , , DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE
<br />MOUND ED CI IfilIDTH LENOIR DEPTH 0101 *210, TO NEAREST: WELL FM:NO.4E0k PROPEINvuNE
<br />livirpAGE TAT* 0 DEPTH SIZE NUMBER 015101401 10 WARM: WELL P-ILINDATiok PROPERTY ONE
<br />sums 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY USE
<br />DISPOSAL PONDS 0 WIDTH LENOTH ELFIN OISTANCE TO NEAREST :• WELL KODNDATION PROPERTY UNE
<br />. HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND INATTNE WORK PAL CE DONE IN ACCORDANCE WITH EMI ..IOADIAN COUNTY ORDINANCES ARO EDATE LAWS, AND RULES
<br />AND Maui-know; OF THE SAN JOAQUIN COUNTY. HOME OWNER Oft LICENSED AGENT'S Eris wart:RE cERT:FiEs THE FOLLOWINS s 1 CENTEFTTNAT IN THE PERFORMANCE OF THS WORK FORM-UCH TIES PERMIT IS ISHOED. I SMAU. NOT EMPLOY ANY PERSON ISSUER A MANNER AS TO BECOME ELIAJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR
<br />SUEI.CONTRADTING taGNATURE CENTIME THE FOLLOVOSIO: ICE WY THAT IN THE PERFORMANcE OF THE WORK FOP. WHICH THIS KRAUT IS 15041W, I SHALL EMPLOY PERSONS Ski/MEC/TO WORKMAN'S71ENBATION LAWS OF CALL 0./ THE APPI.1 Illa MOAT CALL 24 HO A IN ADVANCE 'WEAL!. nEcumuto DISPICTIONS, COMPLETE DRAWING BELOW.
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<br />CATE j FINAL RIOPECTION DATE
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<br />DATE SRI PEWIT LIMN? INVOICE 0
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<br />INCLUDING COVER'
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<br />ADDITIONA4 comurais: rA 1 6/6 ; 5 Aso 1 tr. L.(411
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