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APPLICATION FON"LIOUID WASTE PERMIT <br /> SAN JOEINV RONMENTAL HEALTH DMSIONN COUNTY PUBLIC HEALTH RVICES <br /> SEPTIC <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 SEPTIC <br /> (209)4683420 <br /> Noll-REFUNDABLE PEBMR EXPINEI I YEAR FNDM DATE[MED <br /> ramp Eh H Tdpi ato) <br /> APU:ATION IB NOEBY MADE TO THE RAM JOADUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDYOR INSTALL THE WORK DESCRIED.THIS APPLICATION IN MADE IN COMPLIANCE WITH SAN <br /> JOAWRN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF RAN JOAQUIN COUNTY PUBLIC HEALTH SERVICER/NJ)VNIDFMEEN)TAL HEALTH DIVISION. <br /> JOB ADORES&OR APHI CITY LOT <br /> /V/ - - LOT/N2E <br /> PHONE <br /> OWNER'S NAME C ' ADOREna <br /> •�G .•/ / l�L_`11001EBB/(..4�-. ( �T/ UC1 <br /> .p- <br /> 7�9d R/ONE J� <br /> CONTRACTORy <br /> BUB CONTRACTOR ADDRESS LICO F71DHE <br /> TYPE Of SEPTIC WORN: NEW INSTALLATION❑ RF►ANIUADfNTION DFSTRUCTIOM❑ <br /> OA SEFM SYSTEM PERMHTED IF PUSUC SEWER IS AVAILABLE WITHIN 200 FEET OF HUnDM0.1 PS11C iBEi1R1 f i NOW MANY <br /> �[ AFRSStten I <br /> —7E <br /> W,ALLATION WILLBENE: RESIDENCE❑ COMMERCIAL/1 OTHER❑ <br /> NUMBER OF LJVNO(MTS:_ NUWWM OF SEDWtOMR- NUh76t OF I MPLOYERS: /l /T- <br /> CHAIIACTER OF ROE.TO A DEPTH OF 3 FETT:, r/_RTm+UMP SOIL CHARACTER: WATER TABLE DEPTH/�'G <br /> SEPTIC TAMKIOP"U TMP ❑TYPEJMFO CAPACITY NO.COMPARTMENTS <br /> PKO 711LATMENT FUM ND <br /> ❑ DISTANCE TO NEAREJT: WE71 FOUATION PROPERTY W <br /> UFT STATION❑ 6TJE TYPE OF PUMP ED BAND OIL SEPARATOR(ENCLOSSYSTEM( <br /> LEACRNO UNE ❑ NO.S LEHOTH OF LINES DIBTANCE TO NEARESh WEU. FOUNDATION PROPERTY UNE <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> MOUNDED ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL.--K ��/LFOUNDATION PROPERTY UNE <br /> SEEPAGS P179 IIEFTH�_ORE �T NUMlE11DISTANCE TO NEAREST:Y ME MUMDATV N 2z�l V PROPERTY UNE O <br /> SUMS CI WIDTH LENGTH✓ DEFT" RJISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL PONDS ❑WIDTH UMTH DEPTH DISTANCE TO NE-EST:WELLFOUNDATION PROPERTYLINE <br /> 1 HEREBY CERTIFY THAT I HAYS PEPAPEb THIS APPLICATION AND THAT THE WORK WALL BE DONE IN ACCORDANCE WITH SAN JOAG(N COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> ANO REGULATIONS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AOEJT'S SIGNATURE CERFTES THE FOLLOWING:I CERTIFYTNAT INTHE PHIORRMANCE OF TM WORK FOR WHICH <br /> THIS PERMIT IS ISSUED.1 RIOT EMPLOY ANY FEFWN M SUCH A MANNER AS TO BECOME SUSJECT TO WIOPKMARYS COMIN:NSATON LAWS OF CALBOMSA.' CONTRACTOR'S HIRING ON <br /> 81.18-CONTRACTING MI CERTFES THE FOLLOWING:'1 CERTIFY THAT RI THE m RMANCE OF THE WORK FOR WHICH THIS PERMIT b RSUED.1 MALL EMPLOY PEMONS SUBJECT TO <br /> Cl <br /> WORKMAN'S N LAWS OF CAUFORHIA.' THE APPLICANT MUST CALL E4 HOUR N ADVANCE FOR ALL REOL/IEO NIS"W"'ONS. COMPETE MJG ORAYBELOW. <br /> TTTLE:LDATE: ` !� <br /> i <br /> PLOT PLAN IORNW TO 9CAE3 SCALE 'In <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY- 4.LOCATION OF HOUSE SEWAOE DISPOSAL SYSTEM OR PROPOSED <br /> 2.OVTURE OF THE PROPERTY,WITH DIMENSIONS ARID NORTH DIRECTION- EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3.DNENSIONEO OURIJES AND LOCATION OF ALL EXISTND AND PROPOSED STRICTURES, B.LOCATION EPROPERTY <br /> RE OF WELD WITHIN RADIUS OF ONE MJNDi®FIFTY FT.ON <br /> NLLIUDNJG COVEED AREAS SUCH AB PATIOS,DRVEWAYB,AND WALKS, THE Pro POKY DR ADJOINING Fi10PE1ITY. <br /> Lt <br /> "7 0 <br /> .._« .... <br /> 1 Y r_ <br /> __. <br /> ..... .. <br /> .. ;... . <br /> 0 <br /> a... ... .. <br /> ,.. ..r.. ..; <br /> APR <br /> .A13�1RDN.MNTAL,HILALTH. <br /> ... .... <br /> PPMd�/SERVl6£S;..._.. _ <br /> POR DOAPIMLMT USE ONLY <br /> APPLICATION ACCEPTED ByDATE: J �v AREA' <br /> TAW&OR SUMP IMSPECTKI IY DATE7 )FINAL INSPECTION BY DATE <br /> ADDITIONAL COMMENTS: G <br /> ACCOUNTING ONLY: AD/ FACS JA <br /> PE CODE FFE INFO AMOUNT IIEAII TIBC R RECEIVED BY DATE INVOM[/ F'\ <br /> Pub.Hearth SSI.-E-ft.174(3198) <br /> 1 <br />