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APPLICATION FOR LIQUID WASTE PERMIT SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209) 488.3420 Ute! PffUNPABtE etlflItT EXPIRES I YEAMIROM DATE ISSUED IGIKRI*t* i* TrVmtO APPLICAMN (0 HEIEEY MADE TO TME BAN JOAOM COUNTY FOR A PERMIT TO COHSTRUCT ANDJOR INSTALL THE WORK OESCRISED. THIS AP MAT1d110 MAOI IN COMPUAWC WRH BAN JOAOMN COUNTY DEVELOPMENT TITLE CHAPTER 0-1110.E AND �TTHE STANDARDS OF SAN JOAOUIN COUNTY PUNJC HEALTH *FRVN.EB. EIRRRONMEIRAL NEALTN owwON. f J JOBADOREBWORAFNP� T�'d?3/1� C#" /�yL/7yp C�IT%Y CjfiOG%� ON [/1.07SIZE�i OWNER'SNAME Z4%'�l-Ph �l -rAtJ} n�+�'Cgd NJ- ADDREIB 333 4/�T`F��{,G�T �-+/'.q�.p PRONIJ /I 7925 CONTRACTOR F'y, I �lr'-1--sf V40(vT ADDREBG 4W-15 TL +L+YK"F I_ 4/T/" E LICE '7325" PION 111- 0 9� /� JTKNA C 95�/Z IIUG coWMCTOn ADdREeS UCE r4PDNF TV -W OF *EPTIC WORK: NEW OISTAWITION ❑ REPUIVWDITION Dunn xmk ❑ IND BEPEIC SYSTEM PFAMITTED IF P'ISUC SEWER IS AVAILABLE WTf1RN 200 FEET OF BUURNG.) PPIC TEET611 I WJW MANY ApPI*SSeA N*TAIIATXW WILL SERVE: RLaDENG: IW COMMEmAL 11 OTHER U NUMBER OF LIVING LINT&:_ I Numam OF SuRDOM/: v NUMBER OR EMROY06; _ CHAFIACTPR OF SOL TO A DO" OF 3 FEET:_ C111-4 PITiGUMP SOL CHARACTER: foil'/Y� WATER TABLE DEPFit— 5 *SNC TANKId1FABE TRA► 0 TYPEAAFT «_ rj w V CAPACITY ,_-,_ NO. COMPARTME T$ PKO TAI ATMEN► PLANT 0 IMITANCE TO WAIF&": WELL FOUNDATION PROPEKrY LANE LRT BTATON 0 onn TYPE OP PUMP*AND OIL SEPARATOR IENCLOBED SYSTEM) _ LEACHING LWE NO, a LENOT" OF LINES�� 7 S DISTANCE TO NEAREST: WELLFOUNDATION P11OfiRry LNf RLTTSR an VAUT14 IFNITTH` DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINMOUNDEDWI MOUNDED ❑ DNG WIDTH LETHTJFlfN DISTANCE TO NEATEST: WELL_ F UNDATKN PROPERTY WF TH KIPAGE PIT* ta-DEPZ-� Y WE_/A ' NUSRR _ dHTANCE TD NEAIIST: WELl�P f MA�+_ATLON I % r FROFERTV LINE eI 5T _ *RAMP* El YADTN LENOTN _ DEPTH DISTANCE to NEAREST; NIM__ FOUNDATION FROPERTY LINE OIFFOSAL PONOS 0 WIDTH LENSTH DEPTH DRETANCE TO NEAREST: WELL__ POWDATIDN PROPERTY UFE I HERESY CERIPY THAT I NAVE PREPARED THIS APPLICATION AND THAT THE MARK WILL BE DONE N ACCORDANCE VAT"aAN JOAOUN CDUIftY ORDINANCES AND STATE LAW*. AND BULLS AND AFOULATOWS OF THE SAN,JOAOUN COUNTY. N XK OWNER OR UCET *ED AGENT'S IRONATUIE CERTIRE* TINE FOUAWSIG: 'IGERTEN THAT N THE PERFORMANCE OF THE WOPL FOR WISCH THIS PERMIT N "auto, 1 SHALL NOT 17APLOY ANY PERSON N SUCH A MANAER AB TO BECOM SUBJECT TO WORKAWN'S COMPENSATION LAWS OF CALII'9paA.' COWRACTOWS HIFVM OR SUS'CONTRACTNO SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT IN THE PERFORNINDE OF THE WOFK POR W/*CH TWO PFRMTT IS ISSUED, I SHALL EMPLOY PE"SONS MIBJECT TO WORKMAN'S CCOOUPENSA�TIONNLLA�WS�OF1CALFORMA_' 7HI AFFLICANT MW T .:ALL 24 HOILy IN ADVANCE FOR AV. ROOLNED IN*FBCNONB. COMPLETE ORATING GELOW- SIGNED K TITLE LIF"" R r"' `trE 11 E--� DATE: UQ PLOT RAN DRAW TO SCARLET acAUE_ —' I- 1. NAMEB OF STREETS OR RDApS NEAREST TO OR BOUNDING THE PROPERTY. 1. LOCATION OF HOUSE SEWAGE O*FOSAL SYFTLM OR P IPPOSED P. OFrLIHE OF TIE PROPERTY, WITH DIMENSIONS AND NORTH DIRECTION.EXPAPIiON Of SEWAGE 0181"At SYBTEML a. DIMENSIONED OUTLIVES AND LOCATION OF ALL EXIRNO AND PIOPOIED STRUCTURES. K. LOCATION OF WELLS WITNW RADIUS OF ONE HUNDRED FIFTY FT. ON IVCLULNNO COIARED AREAS SUCH AS PATIOS, DWVE WAYS, AND WALX a- THE PROPERTY OR AOJORIIA PROPERTY. 3jv 1 34 A �. .. ,3 N w : I ,I SEP'l 1 199a t. SAIr JULtLdYUY C{)UNT . PLJOLICt'tEA'T` r-: ' ,....� ,.. ...�.. :_ . L..._ .. 2�" NvIAG iiYicLY,l.I, Nm iLJ t V N :+ _ ...�� ,rte ... ..:.......... .... t��G?2i f �G ANIjI. . FOR DEPARTMENT IDE ONLY I APPUCCAATT.ION ACCEPTED BY DATE' TFJOr, 1'1'I//Q�''�llrP--IT-. BY 1 DATE ! HNAI WBPECTIDH BY GATE 1 ADOLTIOO ALC M'.4TS: Pub. Haa)th SON. - Emir. . '74 (3AG)