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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> • ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,446 N.SAN JOAQUIN ST.,STOCKTON,CA 96201-0388 <br /> (2091 488.3420 <br /> NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> Memplen U Trplastel <br /> Application is hereby made to the San Joaquin Canty for a permit to construct and/or install the work described. This application <br /> is nada in compliance with San Joaquin County Development Title,Chapter 9-1110.3 and the Standards of San Joaquin County Public Health <br /> Services, Envircrmentat Health Division. <br /> Job Addrsssior]] � <br /> A,�PR# �7� (_�]?���7(�C.rs City Lot Si.'AC&/�/� <br /> ONner's NameLa/!/ K lCf/>i`�j Address �' 7IrLP Phone t�//r <br /> Contractor 5��.pGtiTSD>'L yC,/ Address 7�2 Nae �'t Llra.� Lich PhoneeZ 7-�/y��o <br /> Sub Contractor O/!'J/2f11'Yt 7�L Address/2/ f! C,//Gvt[�"V S-1" 0I 4�Phone <br /> v <br /> TYPE OF NBTIC WORK: NEW INSTALLATiOO< REPAIRIADDTTION I I DESTRUCTION I 1 PERC TESSW I 1 Herr maaY--.-... <br /> TWO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) <br /> Lad Use A9pReatLr 7 <br /> Installation will serve: Residence Commercial Other_ <br /> —� Number of living Number of bedss —Wmptoyeess <br /> roo : —ber of a <br /> U Character of Solt to a depth of 3 feet:('/%/oaic4 PIt/Sure soil Character: ( Y t Water Table Depth <br /> NFPTIC TANXloREAgE TiUlP Type/Hfg �BY!�. - t`�y'L— Capacity--ty�Lgeo��t/ Na. Compartments. <br /> PKO TREATMENT PLANT I 1 Distanca to nearest; wet t-/50 Foundation -7Property line�� <br /> LIFT STATIONQ Size_Type of Pump Sand oil Separator (anclosed system) <br /> LEACHINQ LINE -11< No. E Length of Lines Distance to Nearest: Wellfoundation,/`• Property LII» <br /> t� \ FILTER RED 11 Width_Length_Depth " " Well__Foundation Property Line <br /> �✓ MOUNDED U width_length__Depth Weil Foundation Property Line <br /> 1 SEEPAGE PITA X Depth Size 4(2 Number '3 „ Well a Foundation 7e' Property Line <br /> SUMPS U Width Length_Depth wall Foundation Property Line <br /> DISPOSAL PONDS I) Width_Length_Deprh " " Wall Foundation Property Line <br /> {^ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinance¢ <br /> V , and State Laws, and Rules and Regulations of the San Joaquin County. Nome owner or licensed agent's signature certifies the following <br /> �-- : "I certify that in the perfory nce of the work for which this permit is issued, I Shall not employ any person in such a manner Z-- <br /> to <br /> tto become subject to workamnl's compensation laws of California." Contractor's hiring or suircontracting signature certifies the <br /> -- following: P'I certify that in the performance of the w rk for which this permit is issued, I shall employ persona subject to worluren'a <br /> —�� <br /> ;I- <br /> S <br /> of Catffarni <br /> Tia app awlal o ie i rarw far regaha�Iwp 'ol Ce awing below. n��, �.,I!_ <br /> Sig X Titl r.l-r//t�nFrri`rl" Dater <br /> • PLOF PUN (Draw to Scale) Scats "to �,�`�T{ <br /> 7. Names of streets or roads nearest to or bounding the property. 4. Location of house se f —or <br /> 2. Outline of.the property, with dimensions and North direction. proposed expansion of .gYateare. <br /> 3. Dimensioned outlines and Location of all existing and proposed 5. Location of walls wit ygF ft. on <br /> structures, including covered areas such as patios, driveways, the property or edjolnjtjrrtya+lttf. <br /> and walks. r JJt l7U I ` WJ�NTY <br /> iC'. EAL N <br /> IL <br /> np; <br /> t <br /> S <br /> Y r <br /> c -- k <br /> FOR DEPARTMENT USE OXIV `' <br /> Application Acteptad by /� �//� Date; ( <br /> Tank, Pit or ;uJq}inspection by /`�/YAN!-f�L Deta Zt /Final Inspection by Data / / <br /> Additional Conmxnts: hraw./h <br /> ACCOUNTING ONLY: AID# FAC# - <br /> PE CODE FEEINFO AMOUNT NEMTfTEO CHECKO"SH RECEIVED BY DATE $R 1 PERMIT NUMBER INVOICE# , <br /> dD 3 `i <br />