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SIGNED X TITLE: <br />PLOT PLAN DRAW TO SCALD SCALE to <br />DATE: 4:7 <br />APPLICATION ACCEPTED BY Nia <br />c(e...: , FOR DEPARTMENT USE ONLY <br />TANK. PIT OR SUMP INSPECT/014 BY <br />ACCOUNTING ONLY: AID* <br />PE CODE FEE INFO AMOUNT REMIITED <br />t lc. 00 tp- <br />CIIEC ASH RECEIVED ST DATE <br />Ned Ci 12).11 c) ck stAi <br />ADDITIONAL COMMENTS: 3 eGrrefe321i±chAZA4 <br />DATE / FINAL INSPECTION BY <br />AREA: / <br />DATE / 9 ci <br />I PACS <br />INVOICE* <br />Pub. Health Serv. - Enviro. 174 (3/96) <br />APPLICATION FOR LIQUID WASTE PERMIT <br />SA 1 jOACIUIN COUNTY PUBLIC HEALTH SL.. :ICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 468-3420 SEPT C <br />NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />IC.amplate In Triplicate) <br />APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOW DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br />JOAQUIN COUNTY DEVELOPMENT TITLE CHAPTER 9-1110.3 AND THE STANDARDS OF BAN JOAOUyçCOU/4TY PUBLIC HEALTH SERVICES. ENVIRONMENTAL HEALTH DIVISION. <br />GMT LOT SIZE JOB ADDRESS/OR APNF LC° to tiv» F ) <br />°WNEWS NAME \ "COI, e-NAZ‘Liss <br />cc, \...\ <br /> \\c0rY ) <br />to2A4 <br />CCZ 2tg-ti& (1) <br /> - 6191) t.705.11 coNTRAcTon - — ADDRESS HONE I. <br />SUB CONTRACTOR ADDRESS UCI PHONE <br />TYPE OF SEPTIC WORK: NEW INSTALLATION 0 REPAJR/ADDITION 0 <br />DESTRUCTION -74.; <br />INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) <br />INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL' OTHER 0 <br />PERC TEICH I I HOW MANY <br />Apolloodoo <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />CHARACTER OF SOIL TO A DEPTH OF 3 FEET: <br /> PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br />SEPTIC TANICA3REASE TRAP 0 TYPE/MFG CAPACITY NO. COMPARTMENTS <br />PRO TREATMENT PLANT 0 DISTANCE TO NEAREST: WELL <br /> <br />FOUNDATION PROPERTY UNE <br />UFT STATION 0 SIZE TYPE OF PUMP SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br />I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS, AND RULES <br />AND REGULATIONS OF THE SAN JOA0U1N COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 1 CERTIFY THAT IN THE PERFOPPAANCE OF THE WOW FOR WHICH <br />THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AB TO BECOME SUBJECT TO WOWMAN'S COMPENSATION LAWS OF CAUFORN1A. CONTRACTOR'S HIRING OR <br />SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: 1 CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED. I SHALL EMPLOY PERSONS SUBJECT TO <br />WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL ACIDIFIED INSPECTIONS. COMPLETE DRAWING eaow. <br />LEACHING UNE 0 NO. & LENGTH OF UNES <br />FILTER BED 0 WIDTH LENGTH DEPTH <br />MOUNDED 0 WIDTH LENGTH DEPTH <br />SEEPAGE PITS 0 DEPTH SIZE NUMBER <br />SUMPS 0 WIDTH_ LENGTH DEPTH <br />DISPOSAL PONDS 0 WIDTH LENGTH DEPTH <br />(A2 DATE: <br />NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />OUTLINE OF THE PROPERTY. WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />DIMENSIONED OUTLINES AND LOCATION OF AU. EXISTING AND PROPOSED STRUCTURES, 5. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. ON <br />INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALKS. THE PROPERTY OR ADJOINING PROPERTY.