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APPLICATION FOR USUIO WASTE PERMIT SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 45202 (209)468-3420 MON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM OVE ISSUED ICempht.in trlpRmlUi AFTUCATION 10 HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANU=INSTALL THE WORK DESCRIBED.TISK APPLICATION IS MADE IN COMPUANCEwfTH SAN JGA0004 COUNTY DEVELOPME�NTT TITLE. CHAPTER 9-1110.3 AND THE STANDARb`O OF JUIN JOAN COUNTY PUBLIC HEALTH SERVICES,ENVIAO NMENTAL HEALTH DMMN. JOS ADDNEGB/OH APNF �'i C ! S! 7 � l!C _ J�'` //{� CHY J� �` C- _lLOT SIZES 6�' OWNER'S NAME l �+ /♦ /�T� AOPRESS -Z'7 !CJ co NTRACTOR t L .r`C+�L_�� /L. AWAESS �r P-, L!C/ Pjf��53_' PHONE viS�S'r..'I.S BUS CONTRACTOR AOORES6 —LICA PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION 1Apr REPAIRI-01 ON❑ D"TIRve ON ING SEPNC SYSTEM PEAMTTTEO IF PUBLIC SEINER IS AVAILABLE WITHIN 20O FEET OF 8UILDINO.] PEIC TEST--E I Haw MANY AppYAASan I INSTALLATION WILL SERVE; RESIDENCE Lel COMMERCIAL❑ OTHER❑ NUSM6T of uvwo UNITS: / NUMSEB OF BEDROOMS:_NLMM BP EMPLOYEES: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: 33 Prr/BUMP SL CHARAL-Mfl:! WATER TABLE DEPTH SEPTIC TANKAREJUIE TIDE �TYPE;;;�`/ OICAPACITY NO.COMPARTMENTS pKa TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION 6 RMOPF.RTY LINE I�� FfSTA]J01p❑ g ZE TYPE OF R/M7P^� SAND OIL SEPARATOR(ENCLOSED SYSTEMS LEACHING UNE ❑ NO.S LENGTH OF LINES pr, DISTANCE TO NEAREST: FOUNDATION PROPERTY LINE CJ gLTE11 BED ❑WIDTH LENOTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAMST1 WELLFOUNDATION PROPERTY LME SEEPAGE PITS ❑DEPTH SITE ''��5j NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTYIJNE SUMPS ❑WIDTH LENUTH�DEPI'N DISTANCE TD NEAREST:WELL,�r TT-OUNDATION ) PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE To NEAREST:WELL FOUNDAMN PHUPERTYLINE 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THATTHE WORK WILL SE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES ANO STATE LAWS,AND RULES AND REOULAT ONS OFTHE SAN JOAOLSN COVHTY.HOME oWNER OR UCENSEO AGENT'S SIGNATURE CERTIFIES THE FOLLOWING;'I CERTIFYTHAT IN THE PERFOMIANCE OP THE WORK FORWIISCH THIS PERINT ISISSUIED,1 SHATL NOT EMPLOY ANY PERSBN N SUCH A MANNER AS TO BECOME SUSPECT TO woFwmAN'S COMPENSAMN LAWS OF CALIPOPEOA.' CONTRACTOR'B"mm OR BUB-CONTRACTING DMATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PINVOR,IANCE OF THIN E WORK FOR WHICH THIS PERMIT 18 IBBUED,I WDLL EMPLOY PERSONS SUBJECT TO WORKMANTI COMPEHSATUN LAWS OF CAUFCRNRA.-'THE APPLICANT MUST CALL 74 HOTAS IN ADVANCE FOR ALL MOAPA O INSPECTIONS, COMPLETE DRAWING BELOW. SIGNED X__ � 1 -/�' TITLE: PLOT PLAN MRAW TO SCALER SCALE_ -f' 1.NAMES OF 81TWET8 OR ROADS NEAREST TO OR 15OUNDRM THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED I r I.OUTLINE OF THE PROPERTY,WITH DIMENSIONS ANO NORTH DIRECTION. EXPANSION OP SEWAGE DISPOSAL SYSTEMS. J OIMENSIONEO OU UNEB AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION OF WELLS WITHIN KAMa OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY, ... i.. _ i... .. ....... _ .. :.. I�}JO YMfE Pa JUL 21 .199$ PUB NC Ohc7UIN � V ✓=NV1ftONMEN AL" CRH Di 51CJ, FOR OEPAPTMENT USE ONLY 6 AMICATION ACCEPTED BY v r bATE:T AREA: r2l TANK.PIT OR SUMP INSPECTION BY ATE ! ! FINAL INSPECTION B - � DATE ADDITIONAL COMMENTS: GZ 'LZel ALCOIINMIO OM.Y; AIDS FACS 7NC CoOE FEE INFO AMOUNT REMIITED 11 Kl1cASN RL-CBVED SY DAYE SR/PERMIT NUMEER INVOICE S 7a`•1� (l !�U f��-- lar 9d '> � . Pub,HBBI1h Sart.-EnAro.174(3198)