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APPLICATION FOA LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468-3420 IIDIFSEFUROARLE PFRWT EXPIRES(YEAR FROM DATE ISSUED compisES Is Tr""ll) AIR'UCATION IS 4EASY MAU TO THE SAN JOAOUN COUNTY FOR A PEWIT TO CONSTRUCT ANDAR INSTALL THE WORK DESCRIED. TENS APPLICATION N MADE W COMFUANCE WRH SAN JOAOUIN COUNTY DEVELOPMENT ynU.CNAR►i,M S-1110.E AA THE STA�NDAf—OAF OM JOAOUIN COUNTY PVSLC HEALTH WRVKES.FNWONMEERAL IEALTN DPNSION. JOS ADDIIEBSANI ANv__ O /y , J P li,,• 1 r ) /'� (� CRY L/A f Q N LOT NZE I OA oVMEA'S NAME Nl I 10, C ARTINESS_ q,� N' At• COMPACT on L-^S SM CONTRACTOR r, ,, S s 1 L AODIEee u,i_� • PHONE TYPE OF SAiIC WOVE: NEW MSTALLA-11 ROMUAb01TION❑ DEATRUCEPON❑ NO SEPM SYSTEM PDMtRfD E MR SEWER IS AVAI——IN E00 MET of BMIDIND.1 F/IO T1STF7 13 YATW MANY INSTALLATION Il SaV l t: �E40[NC� COMMERCIAL❑ OTHER❑ NUSM OP LMMLIMITS!LTS! /I MISS\\OPT�S""1DROOW M : ALA pP DINtO/T�¢/S CNARACTEn OF SOIL TO A D[/TN OP 3 PMT' y1.} PITRSUMP SOIL CHAnIKTFII:, ,/ WATER TARUE OIF"It— SEPTIC TANgDII.ASE PTIA--►T Q.T+TEnsO_ c/„vl�_CAPAC r M� tP NO.COPAIM.ENT0 tS� Pit*TREATMENT MAW L-J DISTANCE TO NEARiSI': WELL FOUNDATION Q PROPERTY LIRE UPT STAT1oN❑P�SgE TYPE OF PUMP SAND OIL SEPARATOR ICNCLOSED avrtEMl _ LEACNNO UNE EL ND.•IENOTH OF In*S_�� , ._DISTANCE TO NEAREST:WELL FOUNDATION�U AMPNRY LINE Idj2 PRYOR Nm ❑WpT/P LEPIOTH__DEPTH DISTANCE TO NEAPESTe WELL FOUIQATION PROPERTY LIE MOUIIOSD ❑WIDTH LENGTH _DOER pSTANCE TO NEARST:WELL FOUNDATION PROPERTY LAW ASWAON NTS �OEPTM --� @ •1_M/YSFR OESTANCE TO NEARER,WEED NOUNDATWN NbPORY UM SUMPS ❑WOTH LENGTH_OMNI DISTANCE TO NEAREST:WELL,__FOUNDATION PROPERTY LINE ONWUGAL PONDS ❑VMTN LENOTN OMW DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I" EST CERTIFY THAT f HAVE PREPARED THS APPLICATION AND THAT IHE WORK WILL M DONE N ACCOIIOAPCE LAM GAN JOI OIIN COUNTY ORDNANCE@ AND STATE LAWS,AND RIMS AM PEOLRATEONS Of M GAN JOADU I COINTY.HOME OVMM ORLIC9SED AGEMiS @MATURE CETRIFEES THE FOLLOVANO,T CERTTFYTHAT NTNE POR OIRALANCE OF THE WORK I'm WHICH THIS PI1SM S ISIAXX 104ALL NOT EMPLOY ANY PERSON N SUCH A MANNER AN TO BECOME SUBJECT TO WOR EMIAN 0 COMPENSATION LAWS OF CALWOISAA.'6pNTRACTO"MIN OR MS.CONTRACTENO W SIONATURI CIRMIS THE FOLLONA:T CERTIFY THAT INAN THE FEMOPSACE OF THE WRK O POR WMCN TITS PERMIT IT IS ISSUM I INA NO L EMPLOY PENNONS SUBJECT TO PK (� WOMAN'S COMPENSATION OF CA1F{OnNA.• TM A►KWANT MUST CALL]A HOURS IN ADVANCE FOR ALL REQUIRES WSPSCTRONS.COMPLETE OMM/A SRDw, /�\ SgNro A I -4---'TK.cd lam- TRLE:l.N 1 P F,C -fu 0-- DATE: <;^ 13-9 v PLOT RAN DRAW TO SCALER SC.VE IF I.NAMES OF STREETS OR IOAOS SEINER 70 Oft ERTY eOVTRONO THE PROP . E. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 7.OVTLINE OF THE PROPERTY,WRH DIMENSIONS AND NORTH DIRECTION. EAPAHMN OF SEWAGE DISPOSAL SYSTEMS. ].DIMENEIONEO OUTLINES AND LOCATION OF ALL EAIITNO AND PROPOSED OSED STRUCTURES. S.LOCATION Of WELLS WRMN RADIUS OF DIN HUNDRED FETY FT.ON ALLUDING COVCIED APE"SUCH AS IATIO4 DRIVEWAYS,AND WARS. THE PROPERTY OR ADMON NO IRDlERI'Y ...................... F9 �F/ ... ` s.► ^�. ....... 46. F, . ....................... � . lsNY 4Ma.S.r:......... o (..... ATQ w.:. 1retAS�An� .. ... ..................: �. ... ..... ... : ... Yr . ....:. ... ....i..... I.. .. :.41--44A IDS a tf .. .. +LIJ iiuRn , SIT PNVIFIONMfMLI :. . c LYWIa�.I-,. 7/IT tISE ONLY ATON ACCEPTED Irr_ U'l�l �� DATE'—q�l C /JSA:_nNP(Pfi OII SULi MSP[CTgN SY nI DAWj i�INAL NSMCTpN SY ADDITIONAL COMMITS. ACCOUN,"m WAY: Aq/ FKI F!000E FOR RiO AMOIAET ROE Rm /OliPEMPM BT DATE OR I PLTPBAT PIISIAII BIVOICF I Wb.HSBh)r SNv.•EEMro.174(3MQ n O O I 1910 p-