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APPLICATION FOR LIOU10 WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 391, 446 N.SAN JOAOUIN ST,STOCXTON,CA 25201.0381 <br /> 12091468-3428 <br /> NON-REFUNDARLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICnMEna In Triplfsatal <br /> Applicetlon Is hereby made to the San Joaquin County for a permit to construct and/or install the work described. This application <br /> is raids in compliance with San Joaquin County Devetopnent Title, Chapter 9-1110.3 and the Standards of San Joaquin county Public Health <br /> Services, Environmenta <br /> rl Health Division, ,�/ �7y <br /> Job Address/or APMY f'/ Q�� ��L - /W City l AA0EO Lot Size �h% <br /> Owner's N d z diurese LCIL�G f/!/1 a___ F�ZM. -79-S Z 2.d Phor 7 ��/ <br /> 4r>'L�♦ 7>{J Adidresa�e T6 7 % ql L1cY 32£f�S� s 1 d <br /> Contractor Phom <br /> Sub Contractor Address LicY Phone <br /> TYPE Of SEPTIC WORN: NEW INSTALLATION I IlU 001TF0N I 1 DESTRUCTION l I ►ERC TEVel I I Now WT <br /> (NO SEPTIC SYSTEM PERHIITED IF PUBLIC SMR IS AVAILABLE WITHIN 2DO FEET OF BUILDING.) <br /> !sal Use ANRrtea it <br /> Inetellatfon wit( sarve: Rasldence_2�_ Cosraercial Other_ <br /> Number of living unitem__L Number of bedroars�, Humber of employees: <br /> Character of soil to a depth of 3 fasts Pit/SUsP Soil Characcern _ Yater Table Depth L O <br /> SEPTIC TANNHINIARE TRAP U Type/Mf p Capacity_ No. Comportawnts <br /> PNB TREATMEIIT PLANT [ 1 Distance to nearest: Well Foudation _ Property Line <br /> LIFT STAT;0110 Size_ Type of Pup Send Oil Separator (enclosed system) <br /> LEACHING LINE r' No, t length of lirwrs i — 4r,J�r Distance to Nearest: WI I_1_gD}�Fondstlort�Property Line SW <br /> FILTER RED I] Width Length, Depth " Wall_ r Foundation Property Llne <br /> MOUNDED 13 Width LengthDepth " Well Foundation Property Line <br /> NE De / Number � ndetiart '_ ,�/roperty LSno T^� <br /> laws f) Width Lerpth Depth Wel ]( Founds an 7�1�/Ptoperty LSna-y <br /> DISPOSAL PONDS U Width Length Depth " " well FouxletSon n7y Property Line_ <br /> 1 hereby certify that I have prepared this applicatiao and that the work will be done In accordance with San Joegoin County Ordinsnc' <br /> and State laws, and Rules and Regulations of the Son Joaquin County. Mor, owwr or licensed agent's signature certlfies the followl3� <br /> "1 certify that in the performance of the work for which this permit is issued, 1 shall not uaplay any person In such a married <br /> to become subject to work 's compensation laws of California." Contractor's hiring or sub-contracting signature certifies t <br /> following: "I certify that in the performance of the work for which this permit is issued, i shat( arploy persons subject to workmsn� <br /> man <br /> compensation Laws of Californis." (r <br /> The applicant most u_-N 24 bows SV samm*kff all rupials <br /> impostis . Complete drawing below. <br /> Signed X /+ -I �! KTV'[1�r1- Title:Date: - `yJ7 <br /> PLOT PLAN (Drew to Scats) Scale " to <br /> 1. Name of streets or roads nearest to or banding the property. 4. Location of house sewage disposal system or <br /> 2. outline of the property, with dimensions and North direction. proposed expansion of sewage disposal systems. <br /> 3. Dimensioned outlines and location of ■ll existing and proposed S. Location of walls within radius of 150 ft, on <br /> structures, including covered areas such ss patios, driveways, the property or adjoining property. <br /> and walks, <br /> t <br /> s <br /> t <br /> 1 <br /> P 1 � <br /> O Gul CO NTY <br /> PUB IC H ALT SEHVICEF <br /> 414J <br /> FOR DEPARTMENT USE ONLY <br /> Application Accl ad r �2— <br /> Tank <br /> PP by Date: '' `� AreM'. 11_, pl�gpcction by Oate Q�tnel [napectlon by <br /> Audi Ione � ��- ....L�4 '-). <br /> ACCOUNTING ONLY: AIDY FACS <br /> `Ft CODE FEE INFO AMOUNT REMITTED IN RECEIVED NY DATE r/ III I PERMIT NUMBER INVOICE 0 <br /> rY L l ^1 LJ <br /> S�ob05� 0� <br />