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PLICATION FOR LIQUID WASTE PERMIT <br /> S. —aAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 311, 445 N. SAN JOAQUIN $I, STOCKTON,CA 952010318 <br /> (201)4463420 <br /> NON REFUNDABLE PIINIT EXPIRES I TGA FRON DATE 11/912 <br /> K'waisb is TriplaaWI <br /> Application Is hersty wade to the Sen Joa sln Canty for • permit to conetruct "I., Insult the work described. This ppllotlen <br /> I. wed In conpllarWa with Sen Jogaln Canty Deveioprnt Title, Chapter P 1110.3 cad the Standards of Sat Jo.auln CantY Ptbllc Health , <br /> Services, EnVironvar,tsl Health D(iwlslon.///��1 Q //' <br /> Job address/or APYN / / / 7 71 -,t �cityddt_(..1/� Lot Site r. <br /> Owner's W.—IL" Address ►Rr•1a�r--t y <br /> Contractor AddressLIcB�,,3 3 Pham-.i/C�� <br /> Sb Contractor Address Llc/ Phone <br /> TWI 1F tATIC tsar: NEW INSTALLATION RE►AINADORION I I DESTRUCTION 1 I PGC TEtTWI I I New scat{ <br /> (H) SEPTIC SYSTEM PERMITTED IF PUBLIC SEVER IS AVAILABLE WITHIN 200 FEET OF WILDING.) <br /> �" p� Load UUseAFeMd.J <br /> T. Incl btlon WI11 um: Residence [owrrclal� Other `<� ,[ r/1 <br /> Ntaber of 11"M mint_ 1haFber of bsdroose'_ MUM, of a ployoott <br /> Charscto of salt to a depth of 3 feet' /Sup toll Charactort Yater Table Depth <br /> SI►M TAMAIIAOt TM► it Type/Nfo Capacity No, Coeperteents <br /> PER TNGTEEfWT PLANT I ] D1.unce to neared: Well iAn Fardatlony Property lin <br /> LIFT STATIOMO Site Type of Puy_ Sud 011 Separ.ttor (erxlosed $yent.) <br /> LLEATCrNo 1111 Ma. A leryth o/ Ilrwn Distance two Nunsr. vallyy_ Faatdtlon�l` Property Lint[0I] WidthLarythDepth • • Well_ FOUdtlonProperty lin9 t) Width LerythDepth_ • Wall__ Fourewt ion_ Property Line <br /> next(MTB 4A Depth Size Jul' Ntubar_ = Well_ Fou+dtlon_ Property Lim <br /> )\, Nun it Width- Leryth_Depth_ PJMSRO E*jlot+dat Lon_ Properly lin <br /> NI MAEL FOODS I] WIcth_ Lon,th_ Depth_ • Rt'yNt B-rtrP dit dot l on_ Property LIn <br /> 1 hereby cortR; tMt I hon prepared this Tw ln:;t len rd that tM wrt utl G�L�7"CLLI s with Ln Jwp'in Canty Ordlwch <br /> i \ rnd State Lar, rd out" wd ReRulatian of the San JoapJin Cornty. no. owner or Icwr 1ySnt's slprtu.a certifies the following <br /> t •1 certify that In the perforwastct of the work for Mich thla perwit 6AAL'1a1fLR111A�A(IY11kk Mpt y any person In such • srner as <br /> r� to Dacar stb)ect to Norkrn's Capenation laws of Gllforn!a.• Cc4iL1W16T HHkL AIrAHF�S{21MBFfxnt rsctlry slputwe certifies the <br /> J follwiryt •1 certify that In the parforrnce of the work for Jtich (lhYIgQMF,K1Pf11EMlf}J Tl4PLE15"'" person stblsct to rrkr'• <br /> eospenatlmrt�wess of Gllforn <br /> wwla.- <br /> Ts.sptV�wtyJ1 }'Cyws Qy�IQ�_s�w_ Re aN ryyd yaPreees, [septate droving hale. �I <br /> Data:_/y� <br /> PLOT PLAN (Drw to Scale) Scale_• to <br /> t. Nawe of streets er red haareat to o, Laadins the property. A. l«.tion of hone savage dlapwal systaa or <br /> 2. &A.ine of the property, with dlaenelorr anal North dlrectl.n, proposed eapw len of aewpe disposal Systems. <br /> 3. DlNwtsinwd 0,tlirwe and location of all aAlstlry and ProPoaad S. Lacatlon of "it. Within radlr of 150 ft. on <br /> structwn, Inludlry covered areas such a poll.., drlv0-0, the property ac edlolnlry property. <br /> end rlks. 5p ; <br /> J n C - <br /> _ <I <br /> pP IC <br /> FOR PFPAR70 Yit oNIY / 1 <br /> Application AccpxM W <br /> n <br /> 1rt, pit or 1.ap Inspection by Data / / Ilnel Tnepec'lon M Dste 71121Y <br /> Ads!Ill arms,l Cassese,to, 91/;Fti' / J0 // /. 'l�l y_4 s,E-�f✓ — <br /> ACCOUNTING BRIT; AID* Face <br /> n 112E rte MIO ISIOYNT BFMTTIB �wCil/KA+N SEcm1N By DAI I sR 1 PEROT W s MYON:f/ <br /> 'i.'' 11 11 ly roe l'• 1 /V; W,., 7L Ori <br />