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i y� APPLICATION FOR LIQUIQ WASTE PERMIT Siii JOAQUIN COUNTY PUBLIC HEICES ENVIRONMENTAL HEALTH DIVISION my 304 EAST WEBER AVENUE:, STOCKTON, CA 95202 COID (209)468-3420 IIOA•REFWIBABLE PERMIT EXPIRES I YEAR FROM BATE ISSUED IcampMte IR Tdplteetd APPLICATION iB He MADE TO THE BAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPUCATN7N IB MADE IM COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENt TITLE,CHAfP/TER 9-1110.9 AND THE STANDARDS OF BAN JDAWIIN COUNTY PUBLIC HEALTH SERVICER.ENVIRONMENTAL ENVDIOHMENTAL HEALTH DIVISION. JOB ADbRE8BA7R APNS# lO 1 / �/` CRY /�If'7� LOT SII .Q/ � OWNER'S NAME_'_L/ , AbbF1E86 PHONEI-0-7- -7 CONTRACTOR` P-76 AJ !Se ,• „.,._,ADDRESS Zr �. L/L+��il•lI JI L!C/ / (yz L' PHONE *3 7 ` 3 -? SUBCONTRACTOR ADDRESS UC/ PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION REPABUADDfT10N ❑ DESTRUCTION ❑ IND SEPTIC SYSTEM PERMITtEO IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILOINO,1 /] Pi TF.SThI t 1 HOW MANY 4rn�/ /J . INSTALLATION WILL SEITVE: RESIDENCE 13 COMMERCIAL APPNe�Ua�l LIVING /rr OTHER❑��C/l•L�_ NUMBER OF LIVING UNITS: or-BIDROOM6- ®D /SC�I ` t.012F.IAT.MENTOF SDM1 TO A DEPTH OF O FEET PRI8UMP SOIL CHARACTER: WATER TABLE DEPT �� ' K/OREASE TRAP ❑TYPE1Mf Y'�^ 'CAPACITY 0% ' NO.COMPARTMENTS MART❑ DISTANCE TO NEAREST: WELL FOUNDATION �Q PROPERTY LINE_. .S I UFT STATION❑ mzE TYPE OF PUMP SAND OIL SEPARATOR MNCLASEb BYBTENIj` LEACHING UNE 00NO.&LENOTH OF LINES E_-IOc� �.`ncS DISTANCE TONEARESTZWELL.t�OO FOUNDATION_/B(!) PROPERTY LINE FILTER BEP LI WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL+_ FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WL°IJ. FOUNDATION PROPERTY UNE SEEPAGE PITA ❑DEPTH SIZE NUMBER DISTANCE TO NEARESTI R.IW�€L.L ^.. FOUNDATION PROPERTY UNE SUMPS ❑ r• WIDTH LENGTH DEPTH DISTANCE TO NEAREST!WELL FOUNDATION PROPERTY LINE DISPOSAL FONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LIME 1 HEREBY CERTIFY THAT I NAVE PREP D THIS APPLICATION ANb TH E Vii WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULER ANbREOULATIONSOFTHE9ANJOA :N COUNTY.HOME OWNER an EN OAGENT'SBWNATURECERTIFIEBTHEFOLLOWINOI'ICERTIFYTHATWTHEPERPORMANCEOFTHEWOA(-0gWI11CH THIS ISSUED,f NOT PLOY ANY PERSON M SUCH MAN R AB TO BECOME S�U ECT TO WORKMAN'S MAN'S COMPENSATION LAWS OF CALIFORNIA.• CONTRACTOR'S HIRING on BUB C NTMC7 p BKINAT CE E FOLLOWING. CERTI E-#IRPOT9iTANC6 bP THE WORK FOR WHICH THIS PERMIT tip ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO WORK AN'S CO N TIO WYS AU RNIA.• THE T MUS CALL.24 HOUR!IN ADVANCE FOR ALL REO ED INSPECTIONS. COMPLETE L7IRAWING BELOW. SIGNED - 'S �.j 3�� (� Tom: PATE: Q PLOT PLAN MMW TO SCALE►SCALE •to T. NAMES OF 8TREET$OR ROADS NEARE87 TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERtY,WITH DIMENSIONS AND NORTH DIRECTION, EXPANSION OF SEWAGE DISPOSAL SYSTEM8. S. OfMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AB PATIOS,DRIVEWAYS,AND WALKS. THE .PROPERTY aR ADJOINING PROPERTY. 1� :.... .....;..AUG 6 ............ °........ 4 lJlnf OC )U:T ....ENVfRUN0,14FA 7H Sr=F1 4 .................:..............1 ES .... ., ?. .. ;.- .. ..,...., . ..:... ..:.... s FOR DEPARTMENT USE ONLY I. AI'1'LICATIDN ACCEPTED BY DATE: �A.� ,I TAME,PIT OR BUMP FNSPECTIO14 BY ATE_ I „I FINAL INBPEC710N BY ATE--�L-.L-!_..f__I.L,.L_� ADDITIONAL COMMENTS. / N ACCOUNTING ONLY: MDI FAC# PE COBE FEE INFO AMOUNT RIM!ITED CIfECK.1 ASH RECEIVED SY DATE 81111161% TRIMMER MER INVOICE 0 C:2 21 Will (� # I�I i.Heetlh r m.•Ei irD.174(3186) Fe d 4 '