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APPLICATION FOR LIQUID WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />.. 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 466-3420 <br />RDWREFURDARIE PERMIT EXPIRES I YEAR FRDM DATE NSUfU <br />Memp6ty In Tryllutol <br />APRICATION IL HFAESY MADE TO THE SAN JOAOUN COUNTY FOR A rl MR TO CONSTRUCT AND.OR INSTALLTHE MfK DESCPLEEO. THIS APPLICATION NI MADE M COMPLAMu MRH SAN <br />JOAOUM COUNTY OEKLDPMEN.TATM.L CHAPEER 0.1110.7 AAD THE STMDAIOS OF SAN JOAOLKN COUNTY PUBLIC HMIN SERvwES, ENVMI wnwAL NEALTN DIVM ON. <br />.! / _ c— &4 LUT EIIf ,Z <br />JOE ADORE88JOR N'NF <br />OVONEWS NAME_, Vi ADORE88Q [l PHONE- <br />CONTRACTOR 1-IL i L�%�1`�/c ADDRESS ISO_ /%f (,�L�/ o UCI %I, PNON / <br />"CONTRACTOR ADDRESS UC/ MINE <br />TYPE OF SVTIC WORK; MEW INSTALLATION IENASUADDITINN ❑ OEITMJCTION ❑ <br />NO SEPTIC SYSTENI FUNn- EO F P:ISL.1C SEWER IS AVAILABLE NATMN 200 FEET OF SUSDINO.] /BIC TGSTpI E I HOW MARY <br />APFS-S- E� <br />INSTALLATION WILL ■ERIE: RESIDENCE IS COMMEMIAL ❑ THFR ❑ <br />NIMIM EI OF UVMO LITS: N44AO{ OF SGDROOIAW16� MfMEI OF BNROYFEt: <br />CHARACTER OF BOB. TO A OF 3 FEET:_ F7 � ) HUMP SOI CHARACTER:TER TLE D_ <br />S/ <br />SEPTIC TANOPMEA" TRAP D roswFi IJ..Jr! CAPACITY�n AEPTFI <br />NO. COMPARTLENTS _ <br />PKO TREATMENT PIA NT 11 DISTANCE TO WAIRIXT�TW'ETLL FOUNDATION_ 7 PROPERTY WE-g��-� J <br />LRT STATION ❑ 812E TYPE OF PUMP IIAND OIL SEPARATOR ENCLOBEO SYSTEM) <br />LGAC 4" UNG L NO. S LENGTH OF UNES� (' `i OwTANCE TO NEAREST: N'ELI INOATION I�FNOPETLTY LRIE /I" <br />FILTER SFD ❑WIDTH LENOTH� DEPTH INSTANCE TO NEAREST: WELL FOUNDATION PROPERTY IL NE <br />AOUIDEO ❑ WOTH LENGTH­ DEPTH DISTANCE TO NEA SIFT: WELL FOUNDATION PROPOTTY UNE <br />S®AOf MTS ❑ DEPTH we NUMBER DISTANCE TO NEAREST: WELL MMDATION PROF"" UNE <br />SUAF� XWNDTH LENOT" � DEPTH= bISTANCE TO NEAJEFT: MiLL�/ FOUIDATON1 �� DUNE ,5� <br />pSIO� PONDS ❑ MOTH IINGTH DFPTU DISTANCE TO NEAPEM WELL Y FOIFOATION PF60KRT V LOS! <br />1 HERESY CERTIFY THAT I HAVE PIWAREO THIS 1WFUCATION AND THAT THE WOTG( WILL A DONE M ACCOICANCE WITH SAN JOAOUM COUNTY OFONNA CES AND STATE LAM, APD OGRES <br />ANA MOUL.AT10NO OF THE SAN JOAOUM GOUTY. NONE OWNEROR UMNIED AGENT'S SIDNATVIE CERrWKG THE F011VAIM:'ICUM" THAT M THE FEIFOPlAANCE OF TE WORK FOR WHICH <br />TWO MOAT IS PUSHED, 1 wrALL NOT EMPLOY ANY POISON M SUCH A MANNER AS TO SECONE SUBJECT TO WORKMA/N't COMPENSATION LAWS OF CAUIONSA' CONTMCTOIYS HWWA OR <br />SVSCONTRACTMO S10NATTIRE CIKFEIES THE FOLLOWTNO: 'I CERTIFY THAI IN THE PERFORMANCE OF THE WOW FOR WNHCH THIN PEISET M MSUED. I SHALL DO LOY PEmom SULRCT TO <br />WOMMATS CONREHSATNON LAVA Of CALMORMA_' TH K APPLICANT MUGT CALL74 POUM IN ADVANCE FOR AU. IWESOI WYtCTIONf. MlilFfE UNALVSJO BELOW. <br />SIGNED M- Z. /�L TITLE: <br />T-' <br />PLOT PLAN DRAW TO SCALD OCALE_ -c <br />1RE <br />. NAMES OF STITS OR ROADS MEANEST TO DR BOUNDING THE PROPERTY. 4, 4. LOCATION OF NOLME GPWAOE DISPOSAL SYSTEM OR PNOPOtm <br />2. OUTLINE OF THE PROPERT'. WITH OWENSONS AND NOM" 067MMN. IXPANSION OF GE•WAOE pISSY <br />FOSAL STIM <br />J. OVADMONED OUFUNEG AND LOCATION OF ALL EMOTING ANO F OPOSFO STRUCTURES. i. LOCATION OF WELLS WITHIN KAMM Of OPE HUNDRED FRAY FT. ON 0c <br />MCLUOMD CDVOEO REAS SUCH AS PATIOS. DRIVEWAYS, AND WALKS. TIE PROPERrY OR AGJOfRI PROPERTY. <br />— O <br />— ........ <br />. ... PAYMENT <br />w <br />FEB 3199..... ...... <br />...... V .. .. .. SANdCMpTNGy7 <br />._ - ... R1JE{l1Q EAL N SEALTrC�Eg ... <br />p / �^ ENVIRON <br />. y'- ..., ...... ._.. .. MEf,[TALIiEAf3N.l7g .K <br />P. N'r` <br />.......:.. X70 <br />IZ <br />G —4 �� y .... . . <br />DEPAR <br />OED Fgp�UIE ONLY ^ AREA::AREA:APPLICATR ACCEPTBY DATE: j�. /N' ,V � V�rWr`, <br />TANK, NT ON BUMP MSFEC'ETON BY DATE. / I fMAL MSPECTION S4A) <br />DAR_ 2-, Z 3, X14 <br />ADORONALCONMEMO: FL �-" JtL 4 ._ <br />ACCOUNTONO ONLY: I ADE I PACO <br />FE CODE FFf WINO AMOUNT REAITID C ICAGN mcwvw RY DATE M E NWAT wAam 1NVDIDE E <br />L4 1 1 , I +� i5'7c. ! 6 3lRq 2— — --- <br />Pub. Hoeft Saw - Ermto. 174 (3/98) <br />