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APPLICATION FOR UOUID WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DNISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 4683420 <br />NO&REFUN04BtE PERMIT EXPIRES 1 MR FROM DATE ISQE0 <br />IGISPIBb in TrIF1igW `f <br />APPLICATION IR HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A REMAR TO CONSTRUCT ADIDR INSTALL THE WORK DESCRIBED, THIS APPLICATION IS MADE IN COMPUANCE WITH BAN <br />JOAQUIN COUNTY DEVELOPMENT TALE CHAPTER U. 1110.3 AND THE STANDARDS OF BAH JOAQUIN COUNTY <br />'PUBLIC NRONMENTK <br />NEHEALTH SERVICES. ENHEALTH DIMSION. I-/Tp�J <br />LOS AOOPEBBpR/A7Tl/� j y�] l'JT Al2F /�/ iF,1 t7 <br />OWR"6 NAME �-+ ?%� r ADDRESS ! T' 1 n J L L a /L [dnllSCin PHONE c`I <br />CONTRACTOR �7, /:j n _ ADORES I10E P4cNf- <br />BUB COHTAACTOR ADORESS_UCO ?40NE <br />TYPE M SEPTIC WMR: NEW MOTALLATON REPAMUADDITON ❑ DESTRUCTION ❑ <br />INO SEPTIC SYSTEM F[RMTTTEO IF PUBLIC SEWER IB AVAILABLE WITHIN 200 FEET OF BUILDING-) TBrc 1-1.1 1 1 WJW MANY <br />f'1 AFp/aEm !� <br />INSg <br />TALLLTN WILL SERVE: RESOENC5,0!( COMMERCIAL,COMMERCIQ OTHER Ll <br />LINTER OF WINO UNITS.I mUlho I OF ■ S r mukow OF E MRDYEES: ^� <br />CHARACTER Of SOIL TO A OMN Of 3 FFEET:'SA PITf6UMP SOfL CHARACTER: WATER TAN! DEPIF�C_� <br />SEPTIC TANB)01NASE TRAP CI TYPf./A1F0 7/2. cl1PACfi•Y J NO. COMPARTWKTe y <br />PALO TftATMENT KATN-TT ❑ DIITARCE TO WERALT: wELL /Zo FOUNDATION PROPERLY LBE��o <br />UFT STATION LN SIZE TYPE OF P(IFIP SAND 0" SEPARATOR NNCIDSED SYSTEM <br />LTACKNO UNE ❑ NO. S L.fHOTH DF UNEB��� , S [, <br />T— DISTANCE TO NEAREST: WELL ZL—ro RDATION_ PROP4RPY UNE <br />RLTIN Sm ❑WIDTH LENOTN DOPTII DISTANCE TO NEAREST: WELLFOUNDATION PROPERTY LRE <br />MOUND® 0 WIDTH L[NOTH DEPTH D)STAWf TO NFAREST: WELL FOUNDATION PRopf" UNE <br />SEWAGE NTS Q DEPTH BRE _ NUAMER EMSTANCE TO NEAREST: WELL FOUNDATION F OFERrY UNE <br />SOPS IQN� WIDTH LENGTH_ DWFH DISTANCE TO NEAREST: WELL _ FOINDO <br />AT*N PROPERTY UNE <br />pFO <br />SPOSAL POB y WIDTH LMGTN DEPTH DISTANCE TO NEAREST: WEU._ FOUNDATIONPROPERTY LINE <br />I HEREBY CERTIFY THAT I NAVE PREPA FD TNS APPLICATION AND THA,' THE %VO K WILL BE DONE M ACCORDANCE WFTH SAN JOAOUN COUNTY ORDINANCES AND STATE LAWS. AND RULAS <br />AND REGULATIONS Of THE BAN JOAOUN COUNTY. HOME OWNER OR UCEHSW AGENT'S SOHATURE CERTIREB THE FOL UWA RHA! 'ICERTWYTNAT IN THE PFRFOPI RAKE OF THE WORK FOR WHICH <br />THIS PEIII.ET IS ISSUED. N 6NALL NOF' LY./PLOY ANY PERSON IN SUCH A MAARNER M TO BECOLE SUBJECT TO WOPKhWCS COMPENSATION LAWS OF CALIFORNIA.' CONTIIACTOR'S MRNO OR <br />SUB.CONTRACTBD SIONATLIFE CERTEES THE FOLLOWING: 9 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOA WHICH THIS PEIO.ET 18 ISSUlT). 1 SHALL DARMY PERSONS SUBJECT TO <br />WtlISfMAN'S COMiENIATIgN lAW7 CAL1F0 TEE AMUC MUST CALL ZA HOURS IN ADVANCE FOR ALL REOIMI® SfSPBCTLONS. COAMLETY DRAWING SF1.OW. <br />iA/ 9 <br />8KPWO X - / TFICE:_ 12/ NTE: 2 <br />PLOT PIAN G2MW TO SCAPI $CALL ro <br />1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNCING THE PROPERTY. 4, LOCATION OF Notme SEWAGE DISPOSK SYSTEM OR PROPOSED <br />2, OUTLINE OF THE PROPERTY. WITH OtMENSIMM AND NORTH DIRECTION. EXPANSION OF SEWAGE DAIPOSAL SY6r[MB. <br />gMENBION[O OVTUMES AND LOCATION OF ALL EXISTING AND {ROR'06W St RUCTUREB, S. LOCATION OF WELLS WITHIN I AOMIB OF ONE HUNDRED FIFTY FT. ON <br />...... _..___...__ .�.. �....... ....... ..d.......... .... ........ TILE FTowRrY OA ADJdMNO HOFERTY. <br />A,9-,!/, <br />1 R FO�OEPA/TMEIET DSi ERlY /(j �+�, <br />APPEICATpN ACCEPTED Sv `',(Fj,IT'.K'V6,T).!/1' a � DATE: 9 L � ANNA: 21 V <br />�/ (^ C <br />TAW. RT OR SLAW NIDN BPECTBY DATE___L _/FINAL S76PECTION B1' DATE I U 1--q ! `F <br />ADDRLONK COMM ATS: <br />ACCOUNTIIO ONLY: I AIDS I FACE <br />PE CGDE FEE INFOAMOUNT RS/A IT[O C/I6M/ ABN RFCEN� By DATE W 1 FBE.ET N1A�on MNOICS P <br />L u-Fllv(a,;ti9 <br />I 4,,- <br />� , s o o z <br />Pub. He0h Sere. - Envlro. 174 (3196) V t 1j ,- <br />�u -,27 C�(1' E rJ t <br />�� 1 <br />cl <br />