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I I ADDRESS WIA .10051( 1. 11 APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLJC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209) 468-3420 RON.R1TURDAKE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ICernplsts in Trip Haul APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANO/OR INSTALL THE WORK DESCRIBE°. nna APPLICATION TS MAIM P4 COMPLIANCE WITH BAN JOAQUIN COUNTY DEVEL• PM TITLE. 41. R B -1110.3 AND THE ST 0 OF SAN JOAOU1N 0 THY PU8L/C MAUR SERVICES. ENVIRONMENTAL H ALTH ENVISION a • ..tIP CITY .035 ADDRESIND OWNER'S N • 1\ to IL ADDRESS Vedglriet CARTRIMUMIN. t, ucr PHONE ADDRESS SUB CONTRACTOR DESTRUctION PERC TESTI») I ) WIN/ MANY ANAloaton • ITO. COMPARTMENTS PROPERTY UNE TYPE OF SENTiC WORK, MEW INSTALLATION 0 REPAIRJADDITION NO SCENIC ream. PERMITTED IF PUBLIC SEWER IS AVAILABLE WTTIGN 200 FEET OF BUILDIN0.1 INSTALLATION WILL SERVE, RESIDENCE 0 CoMMERCIAL )tr OTHER 0 NUMSER OF UVINO UNITS: 'me, NUMBER OF BEDROOMS: 4S). NUMBER Of Eurtorai: CHARACTER OF SON, TO A DEPTH OF 3 FEET ,A ki D PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH SEPTIC TANK/GREASE TRAP if,-.,,c.vc. CAPACITY PKG TREATMENT PLANT 0 INSTANCE TO NEAREST: WEL12‘26-±- FOUNDATION LIFT STATION 0 Sta TYPE OF PUMP SAND OIL SEPARATOR 'ENCLOSED SYSTEMI LEADHING LINE 0 NO. • t,OT/1 OF UNTO DISTANCE TO NEAREST) WELL FOUNDATION PROPERTY UNE FILTER OED )4 WIOTIfb ' ... LENGTH 1 %." DEPTH 2 DISTANCE TO NEAREST: WEU.'21111+ FOUNDATION 15n t PROPERTY USE 10' MOUNDED 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY USE SEEPAGE ETTA 0 (arm SUS NUMBER INSTANCE TO NEAREST) WELL FOUNDATION PROPERTY UN! SUPAPS 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST; WELL FOUNDATION PROPERTY UNE DISPOSAL PONDS 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WON( WILL RE DONE IN ACCORDANCE With SAN JOAOUIN COUNTY ORENNANCES AND STATE LAWS. AND RULES AND REGULAT/ONE OF THE SAN JOAOUIN COUNTY. HOME ETWILERORUCENBED AGENT'S SIGNATURE CERTIFIES THE FOLLOWSID I CERTIFY THAT IN THE PERFOINAANcE OE THE WORK FOR WHICH THIS PUSAN IS TORTE° I (MALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS 70 BECOME SUBJECT To WOSKSAAN'S COMPENSAlloN LAWS OF CAUVORNIA.' CONTRACTOR'S FIMINO OR SUB-COHTRACT1NO SIGNATURE CERTIFIES THE FOLLOWiNG I CERTIFY THAT IN THE PERFORMANCE Of THE WORSE FOR WHICH RIM PERMIT IS IISUED, I CHAU, EMPLOY PERSONS SUBJECT TO WOTIKMANS COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOWLS IN ADVANCE FOR ALL REOUMED INSPECTIONS. COMPUTE DRAIMNO BELOW. It 0 Inir\ LAM trl DATE2-2 21100 SEPTIC afd 11.4.Vii74741(11 CONTRACT° PLOT PLAN DRAW TO SCALD SCALE I. NAMES OF STREETS ON ROAOS NEAREST TO OR ROUNDING THE PROPERTY. OLNITNE OF TEE PROPERTY, WITH DIMENSIONS AND NORTH DIRECTION DIMENSIONED OUTUNES AND LOCATION OF AU. EVETTINO AND PROPOSED STRUCTURES, INCLUDING COVERED AREAS SUCH AS PATIOS. DRIVEWAYS, AND WALKS. .r,1711Ati.,,e.204‘ ts Eseesni.16- thvir!' v4432-A oRienvoix 2C00. wi\uVria-CA"CejLAVulte% %It 3°0 113404 1..:9Z 6°1;m6. 1S":\P; * 1.4 r-- ), Two IT" • - J.< VoA'D , 1144"4•144 APPLICATION ACCEPTED BY 447 DEPARTMENT USE ONO— DATE TANK, PIT OR SUMP INSPECTION BY DATE 1WDRYSNAL51.9W4HTE _AidlitLasieri________LJ -77pi Lze - • - - ACCOUNTING ONLY AID* Pt CODE FEE INFO AMOUNT ROAMED TEC DATE SR I ST REPER NVOICE S 112-1 c '2-.5 ° q-D,a) 161- -iti ic-Ci) -5 noaQ 7 Pub. Health Serv. • Enviro. 174 (W9.6) 6-0 ,rom....F.J....1.10•110fOrier11141110,.. FINAL INSPECTION BY 1-Mrkir LOT SIZE LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED EXPANSION OF SEWAGE DISPOSAL SYSTEMS. S. LOCATION OF WELLS WRITIN RADRIS OF ONE HUNDRED FIFTY FT. ON THE PROPERTY OR ADJOINING PROPERTY. * ; • YU' - n4 I L15- WDPT'ICSLI -to 00