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i <br /> APPLICATION FOR LIDUID WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DNISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA SS202 <br /> (209)488.3420 r <br /> Ca <br /> NON-REFUNDABLE PERMR EXPIRES 1 YEAR FROM DATE ISSUED <br /> oopkn IB TripWaul <br /> APPLICATION IO HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A/CRIT TO CONSTRUCT AN D109 INSTALL THE WORK DESCRIED.TNIS APPLICATION 10 MME IN COWl1AWI WrT1 SAN <br /> JOAO^COUNTYDEVELDPRAENr TfiLi,CRATER 4-1110.3 AND THEE OTANDAIIDS OP GRAN JJOAOA7IN IXIUNTY HEALTH SERVLICES.OWM1 AENNT AL HEALTH DMSION. <br /> JOB AODfESSTR Ab Nf 1 J L4 z- C 1 1 �(�C� 1 E/LJ JL/\ "TY �`m lar awl <br /> OMYER'S NM1E � .�__ AWPIE311 <br /> CONTRACTOR IA6=1� �i.l�r AOORFOS loco PHONE <br /> BITS CONTRACTon ADOIIE88 LICE 'JPIDHLT <br /> TYPE OF SEPTIC WORK; NEW IRSTALLATMN❑ ROAnrADgnory DNNTRUCTIOM❑ <br /> NO SEIRIC 6VSTEM P{Bylirjm�/Ifo I�411C SEWER IS Al1V� WI1JTiNI/Ny2T00�f{�IET-OP�S G P61C TOTMI 1 1 WJW MAN, <br /> N�__6; [•C r> V V''Vz.•r✓1GJ --'. X•-` A— <br /> INSTALLATION,TILL SavE=NCEf COMMERCIAL❑� OTHER El <br /> NUNSSR W LMNO UMTS. NIMDI OP SEDMOMS: NU(NIM OF b/PLDYNA/ <br /> CHARACTER OF SOIL TO A DEPTH OFB7 FEET=_ �•--��P.R/BUMe SOIL CHARATE <br /> CR: WATTR TABLE DEYEN—_ <br /> SEPTIC TAM14vMF' <br /> 1WE TRAP 11TYR[AE �11.1� C APACRY NO.COMPNO:MEMB <br /> PKO TPWA MMY PLANT❑ DISTMCE TO NEIIRMIT: VAU FOUPOATION PROPERTY LANE <br /> UIPr STATION❑��.SIZE TYPE O!RUMP RANO OR SEM <br /> PATOR(ENCLOSED NYSTEMI f O <br /> LL40ANO EINE / NO.S LENGTH Of LINES_ I S�A DISTANCE TO NEAREST:WELL�TONL_ROFARfY EJNE�� <br /> F/LTIA SED ❑WvTN LENGTH DEPTH DISTAMCE TO NEAMEBIT:MALL FDUPOATION PEIOPERrY LINE <br /> moumt ND ❑WWN LDMTH _DEPTH DISTANCE TO WARIEST:WELLfEG U,ADATIDN�T RIO PEATY UNE <br /> SEWAGE PTS /J��QyDEPTH L BaE 2 IRISIBER�DISTANCE TO NEA SE r:WELL FONIDATIM PIOPARTV UNE lP <br /> MMM 0WDTN LENGTH _CERIN DISTANCE TO WARIEST:WELL__FOUNDATIONPROPERTY EDE <br /> DISPOSAL PONDS ❑WIDTH LENOTII DEPTH DISTANCE TO TEARER:WELL___FOUNDATION PROPO"UNE <br /> 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS AP04 CATION AND THAI•THE WORK WALL BE GONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANC19 ANO STATE LAWS.AND MILES <br /> AND REDULATONN OF THE SAN JOAO XN COUNTY.NOME OWNER OR LCEKI ED AGENT'S SIONATIRE CERTIFES THE FOU OMMI 1 CERTIA'THAT N THE PE/'F01MRANCE OPTW WOPK FORWASCH <br /> TIM PE MTT N ISIUEQ I SHALL NOT BAIRDV A!N N SUCH A MANNER AS 70 BECOME SUSJFCT TO WONKMAYS COMPENSATION LAWS OF CALrOwA--CONTRACTOR'S MISSING OR <br /> SLAICONTRACTNG BONATl11E CEffTSHES TME r-0ll :T CERTIFY THAI IN THE PETiORMANCE OP THE WORK FOR WPPC"TNI.PERMIT NIB M.1 B HALL EMPLOY PERSONS SUI SECT TO <br /> "'A"' TON IAWI Or CALIFORNIA.' APPEECANT MUST EAU."HOURS IN ADVANCE FOR All WOW=MSMTIDNS.COMPLETE CSWWOAI SOD.- <br /> �j <br /> OIONER�I- .� C. » TTnE:_1--t_G:!�-�2e'(, DA,E. /Y � •�3 J�/ <br /> ROT ILMI WRlAW TO SCALE OCALE ._ <br /> I.NARES OF STREF'rt OR AOM■NEAIESr TO OR SOUI`ID"THE PROP9TY. A.LOCATION OF HOUR[SEWAGE DISPOSAYST <br /> SEM OR PROPOSED <br /> 2.OVTLNE OF THE F ROMM.WTH OMENSIONE AND NORTH DIRECTION. EXPANSION OF SEWAGE DWM"AL SYSFEW. <br /> ].OINIENSIONEO OUTLINES AND LOCATION OF ALL EXNTO NAND PROMO STRUCFU1E{. E.LOCATION OF VM"VATNIN RADIUS OF ONE HUNDRED FIFTY R.ON <br /> INCLUDING COVERED MEAD SUCH AS PATIOS.DIEVEWAM AUKS- THE PROPERTY OR ADJONNO PMPCIRrV. <br /> WL' 1 } <br /> ;.. .............. <br /> :..... <br /> .. <br /> : .. ...�-r .. . ..... <br /> ........... <br /> ...... . .. ,. . .... <br /> pAYMA-X .... : . ,,.... .. <br /> ................<..... -6 <br /> V. <br /> J(AniJUbV(.LJU.JIY .. .. ......:. ... ' ..., .:.....'. ............ ,. <br /> PUBLIC HEP1TFfSEFNI n �... <br /> a.rr--6 <br /> L IS <br /> APLRKATION ACCEPTED BY /�� �—�(��` ✓ I _ I/ ��M �i aU�6[pONLY AMAi p2. -1 f q� <br /> 7 <br /> TAK,C I�R SUMP Np4CT1011 BY y"F'rCI I fl�IAVO �/� DATE FINAL FINAL INBPECTIOM SY f !^� OATL,^I CJ / / <br /> P <br /> ADDITIONAL rC O UM EW T Sl' <br /> �i�/! ill Sr1S�Pc'G"I IT4tL••L. Ow.1f,C ••To .Not•l. ✓ '� r 6 w �'ra <br /> ACCOUNTING ONLY: ADI F— SI THE V5.'� <br /> R COOS FEE IMO AMOUNT 119.IIITm < DIMCI{/ tN RECEIVED ST DAT11 SR I PERNT MLAM 1 INVOICTF �~ <br /> Pub.HNIKII Serv..ErI*o,1744%) S h0 20�i <br />