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t�lf��[i<IOR LIQUID WASTE PERMIT _VU-51,1CN C NTY PUBLIC HEALTH SERVICES Ut}�� .'►�-'1�1 D� IR ENTAL HEALTH DIVISION jOAQVjR<;ti. �j, BCC WEBER AVENW, STOCKTON, CA SSM(-388 (209) 488.3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) AP,P.,�L,,IrrC.�ATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN J69IN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESS/OR APNN �/ j� �� f�(,L'C/ / � CITY L(��! LO/T/SIZ GLCG OWNER'S NAME `/(..l,.L L((. .7�-4/�'`j(Q�� / ADDRESS C C �J ,/ PHONEz- CONTRACTOR !>"T'�[� r/J'yS LADDRESS Z-( �.J'�C-G�'C•I:l/ rY7' e LIC# �� PHONES SUBCONTRACTOR �—ADDRESS UC# PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION DESTRUCTION ❑ (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTI)I 1 HOW MANY Applloetlon N INSTALLATION WILL SERVE: RESIDENCE w COMMERCIAL ❑ OTHER ❑ NUMBER OF LIVING UNITS:_ NUM/BER OF PEDROO/N/ NUMBER OF EMPLOYEES: CHARACTER OF SOIL TO A DEPTH OF 3 FEET:�j•9CZs�-LL PIT/SUMP SOIL CHARACTER: ` L�]NATER TABLE DEPTH SEPTIC TANK/GREASE TRAP ❑TYPE/MFO CAPACITY NO.COMPARTMENTS PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ��os 1� �7 p r LEACHING LINE )G,y NO.&LENGTH OF LINES sZ-O(7 r �r�'L�i� DISTANCE TO NEAREST:WELL. ' FOUNDATION.YQ_PROPERTY UNE FILTER BED (❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE SEEPAGE RTS `�❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL-- FOUNDATION PROPERTY UNE SUMPS 0 WIDTH LENGTH_DEPTH��DISTANCE TO NEAREST:WELL 'S3�FOUNDATION PROPERTY LINE S DISPOSAL PONDS /❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOMEOWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PER80N IN CH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUB-CONT TING GN C 1 THE FOLLOWING:' C IFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMA '6 COMPE TION WS C LIFORNI Mi-YLl�CALL 24 HOURS IN ADVANCE FORR ALL REQUIRED II[[N//SPECTIONS. COMPLETE DRAWING BELOW.. SIGNED X, TITLE:021& t./�L_4;4 DATE: PLOT PLAN(DRAW TO SCALE)SCALE "to yrn1 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, G. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. .< .. ........ ......... ...: ..: ...... .. .. _. .... ....... ... .. .. ' .. .. .. .. . . .....:.....; .. - �. .. .. .. .. .. .. . .. ...... ...... .................. ........... ..... ........... ..... ........ ;.. ....... .. ........ . 1 .. .. : :. . ... R .............. ....... . .. . ......... . ................ , s .. . p 3f. :.. ..:.... ..... ... .:._..<........... .. .. .. ................ .. .. .:.....:... ..:.. ..<.....:... .:.. ...:.... . _... ... .. ...,.. _._.: ... ...... .. .. �.. ....................... .. I .. .. ............:.... ......: ..... �1J�.. 0199 >. . ... .. . :... ... .....<.............. .......... .:.._.... .... ............. .. ..... ............ .......... ... .................... _ .. ... y.xS...x�o . . Ai`1 1 +r1i.�.lJli�,l,l�Gl�,it �i S.tA;,A,�s :.. FTY8L 1 (fEALTH SERVICES ..... .............>............'.............. .. .. .. .. .. .. N V Ef;' F,t t°iE AtTW DIV'(510h_ .......... ;;.. :.:.....;... ..:.. ...>.. .:.. .. ;... ..:.. ...:... ..:.....;. .. ..:.. ..;... . :..... .. ..:.. ..............,.............,......<.....:......:.........__>......:...... ......:...... FOR DEPARTMENT USE ONLY __3,e& \PPLIC ATION ACCEPTED BY ' DATE: ( AREA: C/ 'ANK,PIT OR SUMP INSPECTION BY DATE / / FINAL INSPECT ON BY DATE ( J`�0/ L f) ADDITIONAL COMMENTS: Ss-e.G[Q �LC-✓✓4...� S .,/S ACCOUNTING ONLY: AID# FAC# PE CODE FEE INFO AMOUNT REMITTED CHECK11fASH RECEIVED BY DATE 6R/PERMIT NUMBER INVOICE#