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APPLICATION FOR IIOUiD WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209) 468-3420 Y911-pEFUMOARIF PERMIT [XPIRF8 1 YFAB FROM GATE 1$SUED APPLICATION IS H"BY MADE TO THF SAN JOAQUIN COLRRY FOR A PENJrT TO CONSTRUCT AI Pl 04STALL THE WO{R OES F—O. TMB APPLICATWN IS MADE IN COMPLIANCE W RAN JOA0001 COUNRYDEVRORAETTT T{TIX77C'HTAF'TTM9.1`1110.,'11 AMMO THE TTIANf.OA�RDC,Of TANK J�DAOUINCOUNTYINJUKC WALTN 4FI5VILCE6. ENY1ROFf1AE1R/IK�K/1EMTN OSV4510N. F/y JOB ADDRE09" AFTIT_._1291- 3Ao — 10 0fc,r9d I 1(.( l/� �1/.tW,�1 ,W, r(s/tJ�o/r�H/��1 -lLL CHY f dET�-1�ITL.e ky 'rTy f' it '1 LOT BIZE„� "J OWNER'S NAME l ti ,/j In AOCRE. PO, l�,JVl- qc Lbch! IA(Cj'`1`. /1�Tr� O'�� STONE OL��wI 4k3Z-S6e6 CONTRACTOR ufl\o- ryh{d1.'OjL�ii Y•i C -Gum— r�-, %�[-k"-I �}isn l.,yl l.bdI r(VAy J��A PIwNE�l74 y�7�J 7a1 WbCORRRACTOR AOOAESS _ LIC/ PHONE TYPE OF SEPTC WORK: NEW INSTALLATION IEYAavAO[,TION ❑ ocerw CTIOM ❑ ENO SEPTIC SYSTEM PEIVITTEO IF PUBLIC SEWER IS AVAk"LE WrniR1 200 FEET OF bURCIN0.1 P91e TUR•1 I 1 NOW ANMY 1 INSTALLATION WILL T9NE; WICENCE Q CONMERCIU.Q�l— OTHER I] - NLN.fI9R OF WANG LR{TS: NUMT/L OF ITDROOMS: NUMBER OF eVr W VM- LTIAIMMER OF SOIL TO A DEPTH Of a FEET' FTTfSUMP SOIL CHARACTER: WATER TABLE DEPTH 90'"0 TANK9-'MAaE TOA --TP ❑ NPF/MFO CAPACITY NO- COMPARR.IEWIr PRO TREATMENT PLANT 0 DISTANCE TO NTARE,T: WELL FOUNDATION PROPERTY I" LFT STATION ❑ 92E TYPE OF PUMP SAND OIL SEPARATOR $ENCL.OSED SYSTEM) � Lf ❑ NO. S LENUM OF LINES 01STANCE TO NEATEST; WETL FOLITAJATON PROPETRY Loa FILTER SED ❑ WTDTH LEFIOTM DEPTH DISTANCE TO NEAIEBT: WELL FOUNDATION PROPERTY LSIE MOUNDEO ❑ WIDTH LENOTH OEFM DISTANCE TO NFiLRST: WELL FOUNOATION PROPERTY LNF SEEPAGE Rye 13DEPTH SUE NUMBER DIRTANCE TO NEAMOT: WELLFOUNDATION FROFFTTrY LINE TI)AFS ❑WIDTH LENOTN VMFrH DISTANCE TO NFJIPEST: WELL FOUMATKM FFOFERrY LINE DISPOSAL PONDS 11 WTorH LINDTH DEPTH DISTANCE TO NFAIWOT: WELL FOUNDATION PROPERTY LYRE 1 HEREBY CERTIFY THAT 1 HAVE PREPARED TILS APPLICAMN AND THAT THE —RC WILL BE DONE M ACCORDANCE WITH SAN JOAQUIN COUNTY OFpMANCES ANO STATE LAWS, ANO RUE, AND PQOULATIONS OF THE BAN IOAOLMN COI-WrY. HOME OWNER OR LICENSED AO ENT V SIGNATURE CERTIFIEBTNE FOLIDWINO! T CERTIFYTHAT NTME PEPEOFMANCE OF THE W'OM FSR W W H TMB H'ETO.OP LN ISNED, 1 SMALL NOT EMRDY ANY PERSON N SUCH A MANNER AS TO BECOME SUBJECT TO WORLMANI COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HRINO OR SUSCOrITRICTINO SIGNATURE CE TWIES THE FOLLOWWO: M CLTFIIFY THAT W THE PERFOI MAWF OF THE WORK FOR VMPCH TMS rEKWT IS IbSULD. I WALL EMPLOY PERSONS BUS -ECT TO WORKMAN'S ICOr`M��PPFGl!��BB\\A�}}}}TION jrr''��l]]ALVB OF CAIIFOLYAA.• TMI APPLICANT MUST CALF 24 HOR1U IN ADVANCE MMR ALL RREMLOW"rINImPECTTIION�S. COMPLM DMVr1NG NELO[W. �j SIGNED, X-4 `/LLJL/\34�Nl VC XI�I 6/ �U17 (j �i. DATE: l�.,j` 0 TITLE: MDT PLAN DRAW TO OCALE1 SCALE_ - Le 1. NAMES OF STREETS OR ROADPE S NEAGT TO OR BOUNDBIO THE PFUPFILTy. A. LOCATION k--169OF HSE BEWARE DISPOSAL SYSTEM OR PFOPOSM 2. OUTLINE Of MF PROFFRrY, WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE OtWOSA, SYSTEMS. O. "`MENIONM OUTUMES AND LOCATIOf1 OF ALL EMSTING AND PRJPOCEO STRUCTUPER. 6. LOCATION OF WELLY vRTLQL RADRM OF O HAINDI¢D FIFTY FT_ON ...._,.....:..........: ............:...:.....c ......... 1 i ...,_ 'E- DATE:—'/�_(I-/—W—y170 0 _ AREA: r TANK, FIT OR SUMP RMPECTLON BY DATE I I FINAL INSPECTION BY _......<..._.:............ :_..... ;... Al 1�/J .✓ - y <7 i • a i i i f .. IBI, A:ABN RECLINED BY ....... jb,,PERC TEST AND SOIL BORING :..._>. . .,,.; a .r :... _ iL - L - - BRANDT ROAD FEET WEST OF 14YW 88 LOCKFORD 0 FOR .---q ! / APPLICATION ACCEPFED BY '•.� V,%�'�, (1 C � `-01 'E- DATE:—'/�_(I-/—W—y170 0 _ AREA: r TANK, FIT OR SUMP RMPECTLON BY DATE I I FINAL INSPECTION BY ADDITIONAL WNIMENTS' h^ ~.1 Al 1�/J .✓ - y <7 ACCOLOMNOONLY: AOr FACE T'ECODE PR INFO AMOUNT RIFAIITEO IBI, A:ABN RECLINED BY DATE 1411 F(TR.TT N 1. IR INVOICE) Pub. HBGkh SON - EwirG. 174 43198)