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APPLICATION FOP.LIQUID WASTE P:RNIIT <br /> SAN JOAOUiN COUNTY PUBLIC HEALTH `VICES <br /> ENVIRONMENTAL ILEAL r4 O:VIS,,., <br /> P.O. BOX JIM 445 N.SAN JOAQUIN Sl., CTr'CKTON,CA 961010388 <br /> 12031 4680420 <br /> NON Rtrumusu PERMIT EXPIRES 1 YEAR fe6W DATE ISSUED <br /> ICampYW F Trbfaaal <br /> Appllut{o, Is hereby made to the Sen JoeOuln Loo f+r a pe-mit to cmuruct W/or N+Hell the Work described. This application <br /> is Sudo in conpLiam.With Sen J..Wln Canty ..c. I'tl, Chapter 91110.3 and the Stamford. of San JoeQu n Coa6y Publi- xeelth <br /> Services, Erniron,wrtal Health Dlvisla,. <br /> .y"^'A <br /> Job Address/or APNN .. 17 �i {�rN {1 .' 1_' _ _ Cityl J,"1-4, Lot Sire <br /> t <br /> DawPa Macre �<_.�G {,il. ...,It. Ahre s_<< �ix iQ�l�_L� `11C.Ln,u✓,fin i{.:L'.1 Phrx SS1 o711 <br /> (a Y <br /> Cart recFor;�.cnGe'!G C••-�(>_�(c,yr�_ Address bwI FLw•-.•�•= T�- It•1 Mt,�_l1cR 2lll t.(_, Phorc y - Jsti <br /> Sub ConvectorAddress__ __I SCR Phone <br /> TYPE OF SErli'ls,.X: NEW INSTALLATION I I REPAIRIADDITION I I DESTP'JCTIONPERC TESTI.)l I Har auq <br /> (NO SEPTIC SI-:Ew PERH,'NED IF PUBLIC SEWER IS AVAILABLE WITHIN 20D FAEI Of SUILD:NG.) f-'[^+c+-21 <br /> LAN Use A WI)sa W g <br /> Inat.L lserve: Residence Comm -lel Other_ <br /> CYusbsr of misnd,nbsr of Wdromrt_ N.npr of .nptoyata:_ <br /> \ moa;e•:a. .d roll :a a --i- It ! Nest _ Plt/Su,, $.it Chararur: Water Table Depth <br /> SEPTI:TANKIOREAN[TRAP 11 Tvpa/xfg_ _,._ F.apecltY _Yr .aigart.ris <br /> PXO TREATMENT PLANT I I Distance to nearest: Vel(_ _ fourdatlon Prop.. Y line <br /> LIFT STATION❑ Site_ TyFt rT Pure_ Sed 011 Separator (enclosed y.te,$) _ <br /> LEACH310 URE I) No. S length of liras_ Distance to Nearest: Weil_ Fordation,_ Pr.arty Llm__ <br /> FILTER EEO U Width_ Length_ Depth_ • We11Fardatlm_ P,vxrty Llrc <br /> MDUNDEO U Width__ Ltnpth_ Depth " Wel l—FoUdatlon_=Pr.perty Line— <br /> SEEPAGEPITS (I Depth__ Sl to Russo?,— Veil foudet l an Property L I ne_ <br /> LUMPS I) Width— Length_ Dep,h_ " Well_ Fortdst lm_ Property llrc <br /> U <br /> DISPOSAL PONOS Width Length_Depth Welt Fordetlon Property Line <br /> 1 hareby mortify that 1 have prepared this opp(Icaslm ad chef the Work Will be Oona In accordance With S✓ '"pules Canty Ordinencta <br /> and Stott LOWS, And Rvles and Regulations of the San Joaquin Canty. Home owner or licensed agent's slgmtu.0 certifies the following <br /> •l certify that in the performance of the work for Ahlch this permit is Iuued, 1 shall not etpLoy any person In such • Barter a' <br /> (`n to became object to workwn's compena tion lows of California." Cmtractor'a hiring or sub-crt,...ctirg Signature certifies the <br /> 1 following: "I certify that In the Porto ace of the work fur Mich this peredt is Issued, 1 shall esploy persona abject to wrkaanh <br /> ls� caspema an laws of 6111f.e{ri s." _ <br /> OTV SPP ee rNymUaD ES ASM( Nyasa r oRubiY wUaaa. :"opiate Orewi np below. / <br /> Signed 1 L• I// Title: Ar cnLT _Vote: EO Q <br /> PLOT PLAN (Drew to Scale) Scale " to <br /> 1. Nem. of Streets or Fonda ma�es[ ip or bardirp the prnyerty. 4. Location of house swage disposal syabB or <br /> 2. Outline of the property, with di Tons end North r.fnetfa+. proposal ..pwlon of aewogs, disposot gatesa. <br /> 3. Dimernloned wttlms od location of all existing am proposed S. Locotlot of wells ,dthln radlw of ISO f[, on <br /> structures, Including covered areas such as patios, driveways, the property or adjoining property. <br /> and walks. <br /> F <br /> asessa <br /> rz <br /> m' <br /> r <br /> Pla l2 ' <br /> EALN �i r <br /> TOO DEPARTMENT URI GAIN <br /> Appllcallon Accepted by _T. .GtC]N /—W��CT�—_ Data y�yr tam _ <br /> IW, PIE k RNID ItWwllq M Mit s'.-rl t,wr.ow <br /> Additlwal coesMLLs: _ <br /> ACCOVNIINO OMIY: AIDS fACN <br /> PE coal FEE INTO AMOUNT SEMITE EO CHECKAGAIN 11 RECEIVED RYMAT! I O i PERMIT NUMIEN MIVON:S <br /> ZZ 1 CL-1. s1 t� 3� bS <br />