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I <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> RIO.BOX SK 304 EAST WEBER AVENUE,STOCKTON,CA 95201-388 ' <br /> RD%4883420 <br /> M0111-REFUIlPARLE PERMIT EXPIRES 1 YEAR FROM DATE ISSU t <br /> ICBmpwte iR TFipliests) <br /> APPLICATION 1814RE8Y MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANOMK INSTALL THF VK W DESC 7M6 APFUCATK)N 1 AoE IN COMPJANCE Wry"SAM <br /> JOAOUIN COUNTY I)EVFLOPM ITLE TER 8-11 '.3 AANDITHf STAND���NAOVINCOUNTY PUBLIC HFAI TN R BgONME L I/EALTN DIV1tY.OH. <br /> SDP AOOP,ESS:OR APN�' L � �± l LOi BIZFj Aa <br /> F)WNER'S NAME MOORF / PHONE AI'DRFRR / ——_ <br /> .__. LCICA FHON <br /> sVR CONTR 'w-AF _ ��9 CM <br /> TYPE DF SEPTIC WORK: NEW INSTALLATION❑ AUPAm;ADO1TION DffT UCTION ❑ <br /> MMI <br /> O SEPFIC SYSTEM PERMITTED IF PUPOC SEWER 18 AVA:LABLE WITHIN 200 FF ET OF RUIIfM 7 ►ERC TEATIFi I 1 NOW MANY <br /> AFpirrtler.I <br /> INSTALLATION WILL SEI VE:JAI .CEX COMMERCIAL ❑ 1HFA 0NUMBER OF U-0UMTS: NUMBER OF 4Ef1A00M6',,,.._ _ <br /> CHARACTER OF SOIL TO A DEPTH OF 7 FEET:Slq y <br /> SEPTIC TANK!ORFASE TRFrA---P�I ®7VPElMFO Q�L_r ttC� t-`_�rX`.ACIrv_ ��fl NST.COMPARTMENTR v' <br /> PKO TREATMENT RANT U DISTANCE TO NEAREST'. VAL,. _ FOUNDATION _ PROPERTY LINE �•1 <br /> UFT STATION❑ SIZE TYPE OF PUMP flAtiD OIL SEPARATOR'ENCLOSED <br /> SYSTEM) <br /> LEACHNO LII[ A NO.B LENGTH OF UWS O 167ANCF TO NEAREST:WELL Ito FOUNDATION eS Pf1OKm UNE J d <br /> FILTER BED ❑WFDTH LENOTHDEPTH DIRTANCE TO NEAREST:WELL___FOUNDATION PROFEFTY LINE <br /> MOUNDED ❑WIDTH LENOTH �/OEPTN DISTANCE TO NEAREST:WELL 'W FOUNOATgN PROPERTY(1K <br /> B[EP E��T��p�TH �SIIE •aF NUMBFR�I'TAN[f TO NENIE87:WILL IBBw �W,UNOATgN�PERry <br /> tUMM 'v�FIf7F'H LENGTH OFPTH�DRSTAJKE TO NEAIIEST:WELL. rU7E-uy'• -7-ATgN P VERTy UNE T-, <br /> DISroBAI FONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY'UNE <br /> ((Q <br /> I NEPEBY CE N1'THAT I HAVE PREPARED THIS APPLICATION AND THAT THF WORK WILL BE(R]NE KI ACCORDANCE WRH RAN JOAOURI COUNTY ORDINANCES AND STATE'AWS,AND INIEB Fj' <br /> ANO FIEGU TIONS OFT SAN JOAWN COUNTY.HOME OWNEROR LICENSEC AGENTS SIGNATURE CERTIFIES THE F*LLOWNG:I CERTIFY THAT INTHIE PERF0FIMANCE OFTNE WIOp(FOR WHICl/ r <br /> THIS PE IS 18"ID. SHALL NOT EMPLOY ANY PERSON SUCH A MANNER All TO BECOME SLRIACT TO WOWMAN.o COMPENBATgN RANT 01 CALWOPMA.• COFFTT ACTOR'S HWINIG OR <br /> SUP CO RACTING SNSF ATUFW CERTIFIER THE f ''I CERTIN 7HAT W 7HE PERFORMANCE Of THE WK!RA FORYMICH THIS PERMIT 181SBUEO,I S/1ALL EMPLOY►E S Sl1BJFCT TO <br /> WOPI(M 'S ��ANT:�Atl.Z!HOUPS IN ADVANCE FJR ALL RECURBD 7MSPBCTONB, COMgETF DRAWING71wl <br /> ! WDATE <br /> ROT RAN(DRAW TO SCALE;SCALE_ <br /> 1,N FB OF RCET9 OR-AOS NFAPlSI TO OR MIUNDING THE PROPERTY. a.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2.Ol OF T/IE PROPERTY.WfTH DIMENSIONS AND NORTH DIRECTION FTPAN610N OF SEWAGE DISPOSAL SYSTEMS. <br /> 0, DIMENSIONED OUTLINES AND LOCATION OF ALL E%16TIFNG AND PROPORED 6TRUCTURFS, 6.LOCATION OF WELLS WTTHBN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOWNG PROPERTY. <br /> I INS- <br /> IV �,aJ <br /> MAY <br /> " '�IUGLIC HEA,';H SE <br /> ,uNV-R0NMEN'rAL'H'PAi,T.i DIV LI; <br /> FOR DEPARTMENT USE ONLY {' <br /> t\AMM`'Cr/AF�Tf\ON ACCER FO SV t� DATE: V AREA:_/ <br /> 1�4ryK,j 1>jT p¢611F.TP INBFECTgN BV VlI DAfE ^I ! ftNAI RISPECTIO RY DATE����1 "���-'ITTT�j <br /> AD I A COMMENTS: <br /> ACCP UNTINO ONLY: AIDA FAC• <br /> CODE FEE INFO AMOUNT ABMT T ED NEC MASH RECOVED BY DATE ERI pg"T NUMIM INVOICE S <br /> 1 a 7&.3 <br />