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r. APPLICATION FOR LIQUIB WASTE PERMIT R� SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION FILE COPI P.O. BOX 398, 446 N. N. SAN JOAQUAQUIN S7« STOCKTON, CA 85201•Q388 1201 468.3428 SION-FIEFINDARLE PERMrlPIR S 1 YEAR FRQ14 DATE ISSUED rCoMlou in TTyEILabW APPLICATION 43 HERESY MADE TO THE tAN JOAQUN COUNTY FOR A PERMIT TO CONSTRUCT ANOIOR INSTALL THE N,CIK DESCRIBED. TT018 APPLICATION It MADE N COMPLIANCE WITH SAN JOAOUIN COUNTY DEVELOPMENT TTTLE, CHAFFER 8.1 T 10.3 AND THE STANDAROC OF SAN JOAGNN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH C0.190h. JOB ADORESBIOR APNN, � T-i—mow C�.-L��'�'�_ w CITY ICIPZ�V CA _LOT 87E 2 )qepvL OWNER'S NAME /1E'Ale �S App�iB . y, - - �y RHONE. �j CONTRACTOR l e 1 `*��:-iL=-l- ADORE" Lti L.'7ra— {k LICr 3-/i6 P410xE PI &5a BUB CONTRACTOR —as ucr IMGNF TYPE OF *EMC WORK: MEW INSTALLATION ❑ REPAIWAOOITION OTATRUCTION Q ONO SEPTIC EYETEM PERMITTED N PUIRM SEWER 18 AVAILABLE WTHIk 200 FEET OF BUILOINLL.R I l 1 NOW MANY Apglwtell s IMETALLATION VAIU-SUVE RELVOCI CE COMMERCIAL ❑ OTHER ❑ NUMBER OF LIVING UNITS: I NUMMM OF BEDROOMS:_ 3 NONBBE OF 11IMFwYPEA. CHARACTER OF BUIL TO A DEPTH OF 3 FEET: J;AW:'% PIT/BUMP SOIL CHARACTER: WATER TABLE DEPTH SFPrIC TANKAGRLULE TRAP ❑ TYPE/MFO_—I^— CAPACrTY NO. COMPARTMENTS PKIl TREATMENT PLANT 13DISTANCE TO NFJU W: WELL FOUNDATION PROPEF4TY LINE UFT STATION ❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR (EEH:LOSED SYSTEM) LEACXNO LINE W -NO. 4 LENGTH OF LRaB L DISTANCE TO NEAREST: WELL`�I FOIlNOATIOH d;/of FROPE{Oy RLT61 an d WIDTH LENGTH_- DEPTH DISTANCE TO NEAREST: WELL RIUNDATION PROPERTY LINE MCUNOEp R WmITH LENGTH DE tE77A� W78 Q DEPTH 812E FrH DISIANCR TG NEAHEBT: VYELL� r-OUNDATION PMKKrYLINE _ NUMBER DISTANCE TO NEAREEf: WELL FOUNDATION PROPERTY LINE BUN 0 WIDTH LEMOTH DEPTH OWANCE TO NEAREST: WELL _ FOUNDATION PROPERTY LINE DISPOSAL PONDS Cl WIDTH LENGTHS DEPTH IMUrANCE TO NEAREST: WELL_ FOUFmATION PROPERTY LINE I HEREBY CEFTIFYTHAT I HAVE PREPARED THIS APPLICATION AND THAT THE W0fK WILL BE DOM: N ACCOFmANCE WrrH BAN JOAOUN COUNTY0PUNANCE5 AND STATE 7AW'3, ANO RI1l.E8 AND RMUI ATIONS OF THE SAN JOAQUIN COUNrY. HOME OWNER CR UCENBEp AGENT'S SIGNATURE CERT6IEB THE FGUUVYNLL: •I CMIFV THAT N THE IEAFOF""CE OF TME WORK WR WItCH THIS PERMIT 13 MSUF.D. I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WDWjAAN•S COMPENRATMN LAWS OF CADFORMA.• CONTRACTOWD HEaNn OR BUBCONTNACTNG SIGNATURE CERT"O THE FOLLOW) : •I CERTIFY THAT N THE PERFORMANCE OF THE WOW( FOR WHICH THIS POWT IS LSSUED. I SMALL EMPLOY PERtGHE SUBJECT TO WORKMAN'S COMPENSATION LA///WS OF CALIFORNIA; I1H APPLICANT MUST CAL. 24 HOURS IN ADVANCE FOR ALL REO�U,HJ1= MW INSPECTIONS. COMPLETE OM BELOW. SICNEb i I G–L, P- TIf1F.: � 4 GATT-` • " � - • J PLOT PLAN (DRAW TO SCALER SCAIJE • m T, NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PnOPERTY, A. LOCATION OF HOUSE SEWAGE 018MM SYSTEM OR PROPOSED 2. OUrIJNE OF THE PROPERTY, VMN DIMENSIONS AND NORTH OIRECTON. EYPANLEGN OF 9EWAOE dSPOtAL WBtE'LES. 3. OIMENBIONED OUTLINES AND LOCATION OF ALL EAESTNO AND PROPOSED BTRUCTUIES E. LOCATION OF WEWA VMTION RADIUS OF ONE IRINDRED FORTY Ff. ON IN[LubINO COVERED AREAS SUCH AB PATIOS. DRIVEWAYS. AND WALICB. THE PROPERTY OR ADJOIMM PROPERTY. . .... .......... : i - ....... .. .. .. r. - :. PAYMENT �' T 7 7 X994 e' SAN J{IAOUI UN F 10. P LIC �i .4L- A SEs ` , :.. i1'' l �J FOR OfvARTMEMT USE ONLY �J APPLICATION ACCEPTED BY DATE:_ry I. -L_ n AIEAe TANG, PIT OA SUMP SNBPECTiON BY ATE _ I FINAL INSPECTION UY DATE / I , / r . r. TIONAL CDMMFNTB: ' �7 -7- /f L�,r bL dX . ONLY: I JUDO I FACE R61N7Tm C !CASH RECMVEO ATE an I P9BUIT mx mmB L GIVDIeE f