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poi c a,b <br /> APPLICATION FOR LIQUID WASTE PERMIT `J <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 308, 445 N. SAN JOAQUIN ST., STOCKTON, CA 95201.0388 <br /> (209) 400.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IComplitB in TripliuMl <br /> APPLICATION IB HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> "AMIN COUNTY DEVEIDPMEM TITLE,CHAPTER 9-1110.3 AND <br /> THE STANDARDS OFF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH OIVIBION. <br /> JOB ADDRE88/Oq CRY <br /> �.i,/c.s S �}GPL- 1 OYl2 %2'70 <br /> / To / L ,[ CTIY/J/`L'('[Z_/JJ� LOT�162E�f{[21L� <br /> OWNER'SNAME l IAV rxi� ,.Mf��+%%C� ADDRESS 2 I D,�.. eL"6t S2�ee�Y ;Z' .���/!>� ����y/�� PHONE 3(0 /- I,r� <br /> CONTRACTOR_ TT /oYl SYY�IJ>L ADDRESS jZ� (!A"4a-'1/ OI-• SAM# T0VZ2 r PIbNE <br /> SUBCONTRACTOR ADDRESS LICI PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIRIADNTION 13 DFSTRLICTION (3 <br /> IRO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AV ILABLE WITHIN 300 FEET OF BUILDING.) PERC TUTp)I I HOW MANY <br /> T-1 AppNoetlon l <br /> INiTALLATION WILL{RIVE: RESIDENCE COMMEIICIAL 1313t`NOTHER m <br /> NUMBER OF WING UMTC_Z_ NUMBER OF BEDROOMS: 3 NUMBER OF LMPAYEFJ: <br /> CN ER OF SOIL TO A DEPTH OF 3 FEET: CL<s PITAIUMP SOIL CHARACTER:i ft �/d'B Ey WATER TABLE DEPTH <br /> C T E TRAP 11 TYPE/MFG -�I,- 1 <br /> CAPAGT'_ I?OL9 o/ NO.COMPARTMENTS oZ <br /> TREATMENT RANT❑ DISTANCE TO NEAREST: WELL 1QL FOUNDATION /7 PROPERTY UNE 74 <br /> LIFT STATION❑ SIZE TYPE OF PIMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) --P <br /> IFJOMNO UNE lFp NO.S LENGTH OF LINES <br /> / ISTANCE TO NEAREST:WELL /O[� FOUNDATION ZS ' PROPERTY UNE <br /> ALTO am ❑WIDTH LENGTH D PTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> MOUNDED ❑WIDTH LENGTH DEPTH INSTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> GEEPAGE ATS DEPTH aS, 32E -310" NUMBER_ DISTANCE TO NEAREST:WELL ).! FOUNDATION FF K,TY UNE 7S_ M <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL POND{ ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> I HERESY CERTIFY THAT 1 HAVE PPEPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES Q <br /> AN GU ONS OF THE SAN JOAQUIN COUNTY.HOME OWNER ORLICENSED AGENT'S SIGNATURE CERTIFIES THEFOLLOWING:•I CERTIFY THAT INTHE PERFORMANCE Of THEWOR(FOR WHICH <br /> IB PERMIT XGSIGN <br /> ALLNOTEMDYANYPERSONINS MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMRENSATON LAWS OF CALIFORNIA.• CONTRACTOR'S HIRING OR <br /> NTRAEIFIE7STHE FOLLOWING:•I ERT) THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMKOV PER$DNS SUBJECT TO <br /> MAN'SALIFORNIA.' THE ANT UST CALL 24 HOURS IN ADVANCE FORRALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. t <br /> SIGNED% TITLE: 1 QBQ BATE: �ROT RAN(DRAW TO SCALE)SCALE1. NAMES Of STREETS OR RST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PHORERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON L <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> iT <br />