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APPI.ICATION FOR LIOUIO WASTE PERMIT SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH 01Y1310* K0, BOAC W&304 EAST WEBER AVENUE, STOCMN, CA MMI-388 12091400-3420 TION-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED lCaroplata in Triplkalal APP13C AT1ON IS K7AFBY}AADS 10 THE SIN JO►G.UIN COUNTY FOR A PERMIT TO CONSTRUCT AM"INSTALL TYPE WOW OESC•RIOED. THIS APPLICATION 16 MADE IN COMP'JANCE WITH BAN JOAUVIN COUNTY LVVELOPMENT TITLE,CHAPTER 9-1110.3 AHD THE STANDARDS OF BAN JOAQUIN CQUNTY PUBLIC HEALTH SERVICES,ENVHWNMEWAL HEALTH O0,13"m. JOB AbrDRESBVOR APNr - � olG�is2 yq", CITY - _ }n/_ LOT SIZE_Z/4.r-c� DYJTIER'S NAME T� 1 ZZ, /1ODI1f88 ` PHO'KE CONTRACTOR 1 J� y't--. ;J�[� AI)DAEss "( �r FPIpT1F SLIM CONTRACTOR ADDRESS me PHONE TYPE OF SEPTIC WORK: NEW INSTALLATIOM❑ REPAPPIMO ITION DESTRUCTION❑ INC SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN ZOO FEET OF BUPLOR 1.1 PERC TEST14( I HOW MANY Appan�tlaR/ INSTALLATION WILL SEILVC: RESIDENCE COMMERCIAL❑ OTHER 0 NUMBER OF LIVING UNITS: _ _I NI1Mfi91 ttF R1111iIDOMS:�� NUMd61 OF DHPLp+W-. CH _ OF SOIL TO A DEPTH OF 3 FEET; PITIBUM,PP g^01L CHARACTER: tr%j.WATER TABLE DEPTH � 'C_ • -W / �1�7!T EAJE TRAP TYPERFC CAPACITY- NO.COMPARTMENTS ^'7{ PK43 TREATMENT PLANT❑ DISTANCE TO NEAREST-. WELL �5 Li' FOUNDATION t:) PROPERTY LINE -'n r LIFT STATION❑ SIZE TYPE OF P0AP / $IND OIL SEPARATOR IFHCLfOBED SYSTEM, LEAC1aNG LINEHO,a LENOTH OF LINES - �L�1 r' "I �DISTANCE TO NEAREST-WELL FoUNOATFOH PmPERfY LINE f FILTER S� WIDTH LENGTH OEpm DISTANCE TO NEAREST-WELL FOLRODAMN PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE PITS IWMPIN ?rj 912E_ -3 G- NUMBER_ DISTAHC£TO NEAREST.-WELL 7`^FOUNDATION —70 PROPERTY LINE 1['•} BUMPS ❑WIDTH LENOTH DEPTH DISTANCE TO HEAREST:WELLFOUNDATION PROPERTY LINE 1 DISPOSAL POND/ ❑WIDTH LENGTH QEpIH DISTANCE i0 HEAKST:{HELL_ PpDAtDAT10N PAIOPf}IfY LINE I HERESY CERTIFY THAT 1 HAVE PREPARED TF11$APPLICATION AM THAT TH WORK WILL BE SONE IN ACCOIVOANCE iIYITH SAN JOAt1111H COUNTY ORDINANCES AND STATE LAVYS,AND RLRFS IN Q TIED F THE SAH JOAOUIN COUNTY HOME OWNER 09 EDIT'/6lGliATUPE CERTIFIES THE F�tLOWYss:'I CETiIIFYTHA7IpTHE PERFORMNdCE OF THE WOIK FSR WHICH THIS PE Is ISSU I T E PERSON IN SUCH A M E'AS TO BECOME SUBJECT TO WOMMAN'9 COMPENSATION LAWS OF CALIFORNIA' CONTRACTOR'S HR{INS OR SUBS NTRACTING 310 URE RT lE HE F lMIiNO:-1 CERTIFY T T IN 'HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I$HALL EMPLOY PERSONS SUBJECT TO WO AWA COMPEN N F A IFORNr THE T CA .20 NDUR/LN ADVANCE"R ALL REQUIRED INSPECTIONS. COMPLETE ORAWINO BELOW 61ONE0 Tr-LF' DATE: P V PLOT PLAN,DRAW TO SCALEl SCALE 1. NAMES OF STREETS O ADB ARM TO OR BOUNDING THE PROPERTY, 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PWPOSED 2, OUTLINE OFT 14C PROPERTY,WITH NSIONS ANO NORTH DWCTION. EXPA14SION OF SEWAGE DISPOSAL 11MEMO, 7. DUAEN13KMED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCAT19"OF WELLS WITHM RADIUS OF ONE HUNDRED FIFTY FT_ON INCLUDING COVERED AREAS SUCH AS PATIO B,DRIVEWAYS,JWD WALK 0. - THE PROPERTY OR ADJOINING PROPERTY. It1tif .LI �Z l4 _TVA idIIV1,1996 FOR DEPARTMENT USE ONLY ff. .. 1- --'.J f ;.rl•-I, �. � Ahf'LICATION ACC EF'SED BY DATE: _44 i _ J tJ� l _ AI1EA:_ ! TANK,PIT OR SUMP INSPECTION BY DATE y 1 1 FINAL IN$PECTIOH OY _�f�>�4'5AJ2 y��DATE I•� 1 �1��a ADDITIONAL COMMENTS_ ACCJUNTINO ONLY: AID, FACR mLCOPE FEE INFO AMOUNT RObNTTEb CHEC ASH RECEIVED Sly DATE IM I PT NUM69I INVOICE 9 ? I L