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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES PTIC ENVIRONMENTAL HEALTH DIVISION T" 1 1 <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> • ' (209�aea-3azo � � Yid �O� <br /> XP REf ! II FfOM DATE If U �� -Y <br /> IR TripNutt} <br /> APPLICATKNN It NEREOY MADE TO THE SAN JOAOU N COUNTY FOR A PE)SART TO CONSTf T AND"INSTALL THE WOPIC DESCRIBED. THIS APPMATIO (e MADE N COMRIANCE MTH SAN <br /> JOADUN COUNTY DEMOPMFNT THe,CHASER 2-1110.3 AND THE STANCAAD2 Of SAN JOADUNI COUNTY PUBLIC <br /> HEALTH FRU LND.T SIZE <br /> JOeADORE,,,,,AN19Z33 WA�RRo C.T. AQ11"103a5ro cr" � <br /> OWNLT'SNAME AL. # MhRO GnMet- AOOI tIA0yWl PHONE -iSI�-I�OO <br /> CON7RACTOAMA, /_ZDD►1kLD -4 5►k"ItC T-NCI ADDRESS 5`6050 E PIP]RR76 -D• Mo 75q 598 PHONE 3fL Z ,I <br /> SUB COMIACTOR ADCIESS LIC/ PHONE <br /> TYPE OF SEPTN.MORN'. NEW INSTALLATION❑ REPANI—DITION❑ OEAtRUCTIOM❑ <br /> INO/EPTIC SYSTfM PERAfTTEo IF PVSLIC SEWER IS AVAJ AME WITHN 200 FEET OF MRLDINO.I Pe1YC 7LTb1 I I HORN MAN`! <br /> Iw <br /> APPAsbw E <br /> INNTALLATION WILL SERV! RESIDEME OD MERC COMIAL❑ OTHER❑ p <br /> NUMBER OF U%n"UNITS: I RISAem Of RED DIMS: 4 NU IRA Of EARD"M: L... <br /> CHARACTER OP SOL TO A DEPIH OFpp2 fEET: W I? PTIBUNAP SOIL CHARACTEJI: V WATER TABLE DEPTH <br /> SEPTIC TANKIOREASE TRAP lff ro AATa tmlo CBHI( . CAPACITY 1.l6b D NO.COMPARTMENTS Z <br /> I <br /> PKD imATMOIT RANT❑ DISTANCE TO PILN IT: WELL loo+ FOUNDATION 10' PROPERTY Um 10 <br /> LFT STATION❑ SIZE TYPE OF P/MP SAND OIL SEPARATOR ENCLOSED$YSTEMI I + <br /> LEMMING UNI 0 NO.S LENOTH Of LINES Z (/O F DISfANRCE i0/1E/1NIESf:WELL 100 J+ FOUNDATION 7-0' PROPERTY LINE �JO <br /> 1 <br /> FRYER an ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNOW O WROTH LAZ <br /> rP IENOTH DEPTFL EL DISTANCE TD NEAREST:WL FOUNDATION PIOFEENTY E <br /> S®AOS PITS ®DEFT" A-'G I tl2E �2,f HRNANEH 4 dRAFCE TO NEARER:wELL ISO FOUNDATON :501 PfOPEFUY LP* ZO I <br /> SUMPS I❑N-LR WIDTH LENOTN OE►TN OR NO <br /> TANCE TO NEAREFT:MMI FOUNDATION PPERTY LME <br /> DISPOSAL PONDS LJ WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE CONE N ACCORDANCE MTN SAN JOAOUIN COUNTY ORDINANCE$AND STATE LAWS.AND RUES <br /> AND NEDULATRNB OF THE SAN JOAOUIIN COUNTY.HOME OWNFH OR LICENSED AOENT't eIOHATINE CEWIFES THE FOMOWNNO:'I CENfIFY THAT N THEFEIIORIAANCE OF THE WORK PORMRIICH <br /> TARS PESAT IS ISSUER I SHALL NOT EMPLOY ANY PE180N N SUCH A MANNER As TO BECOME f UsL ECT TO WOIKMAW 5 COMPENSATION LAYS OF CALSOPNA'CONTRACTORS MONO OR <br /> SUB,COMPACTIND EONATU S CERTWIES THE FOLLOVM40:9 CERTIFY THAT N THE PERFORMANCE OF THE WOK FOR M WM THIS PE S41T IS ISSUED,1 MALL EMPLOY PERSONS SUS FECT TO <br /> WOW AWS COMPENSATION LAWS Of CALIFORNIA.' TINE APROCANT MUST CALL 24 NOW IN ADVANCS YOM ALL R[OYSm EMFlCTIORt.COMPETE ORAWINO SELaW. <br /> NONED K � mLL, DATE: <br /> ROT RAN IDRAW TO SCALE]SCALE—'N w <br /> 1.NAMNS Of STREETS OR ROADS NEAREST TO OR POUNDIND PI THE DPEREY. I. LOCATION OF NDUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2.]URINE OF TP!PIIOPERTY,WITH DIMMSIONS AND NIORfM DIRECTION. EAPANOON Of SEWAGE DISPOSAL SYITEMS. <br /> 3.DIMENSIONED OUNINES AND LOCATION or ALL COSTNA AND PROPOSED S RUCTUIES, L. LOCATIONROPE T WEARSJOINI N TROPE TY ONE HUNDRED FIFTY R,d/ <br /> DSCLUDNp COMSED ME"SUCH AS PATIO$.DRIVEWAYS,AND WAULB. THE PROFVNIY OR ADJOINING PIIDPENUTY. � <br /> QI <br /> o,-�1 <br /> } <br /> a. <br /> • O <br /> a9 <br /> YMEN <br /> E�CEIVE <br /> ,1� r 1 1 6 2001 <br /> 9N P�JQHal1•Li N �� <br /> ENV4RO <br /> OR 04EP MT USE ONLY <br /> APPLICATION ACCEPTED BY DATE- AREA: <br /> TAM,PTT OR WARP IILPECTIOI/B -�-�' C6FINAL INS DATE / /T <br /> DATE !Q� <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING ONLY: AIDS PAC# <br /> R COO! FQ 11R0 AMOUNT RRNNITED CINEC A:A.SN R SY DATE SPIPOSNtT RLOMM NIVOWE <br /> HEEL f is o C 00-277 <br /> Pub.Heaflh Serv.•EIINro.174(3/96) <br />