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. e APPLICATION FOR LIOIIIO WASTE PERMIT ,AN JOAQUIN COUNTY PUBLIC HEALTH SERV ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)488.3420 QR•REFIIR81187 PERRgj2T1RF9 I YEAR FROM DATE ISSUED (Complete In TFlplleuil APFLICATION{B NTREBY MAGE 70 THE BAN JOAOUINCOUIRY FON A EEMOT TUC ONSTRUCT AND/OR INSTALL THE WOR(DESCRIBED.T/OB APPLICATION 10 MADE IN COMPLIANCE WITH BAN JOAOUIN COUNTY DEVELOPMF TITLE.CHAPTER 0-1110.2 AND THE STANDARDS OF am JOAQUIN CCVNTY PUSIIC NFALTN BERVICEB.ENVpONMENTAL HEALTH DMMM. roe ROOT EBBKIR APF7r /y N4-C)I --oq O-03 V.s2�/�Ye�Ar/�m i`+ qp-�a�f y�C ygd j Lot OFF 154 Acre OW11EN•8 NAME�r}TOr F{S,51111eYliDme Wlnt1'uA-MOM 100 main!;I,St" -�I,a..CA PHON 707 310+ F cDHrrtecronCD+1a012 EaeADD{ ,B sFf'kt�t%k5fareles'1�2,St�ck F PHO 4-bsla t BUB CONTRACTON D rI linq A0011E-B MP-Hdrnrnpn,1 ..., LICr�D 179 PHU 0 aD — I I fTYPE OF OFPNC WORD; NEW INSTALLATION PPFADVADBITION0 OBSTRUCTIONU IND SEPTIC BYBTEM FERLIITT EO IF PUBLIC SEWER IB AVAILABLE WITHIN 200 FEET OF SUILMNOJ PHtD TFSTI-I 1 I IIDW MANY" AppisSeB I INSTALLATION WILL SERVE: momrMCE❑ COMMEncIAL A OTHER 13 NUMBER OF LIVING WIITVNom_NUMBER OF 1EDROOMS: NUMIRM DPL IA1pI.DYEFS: 35�g �er -r yea les CHARACTER OF IM TO A DEPTH OF S FEET: I PTTASULAP SOD,CHARACTER; WATER TABLE DEPT 3-8 44-e- y BFPTICTANK/m1EASSTRAP ❑TYPFJmpo CAPACITY NO.COMPAMMENTO PHO TREATMENT PLANT❑ DIOTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE LIFT STATION❑ BRIE TYPE OF WIMP *AND OIL SEPARATOR 1ENCLOBEO SYSTEIII i IElCRNO UNE ❑ N0,14UNGTROFUNtA DISTANCE TO NEAREBII WELL FOUNDATION PROPERTY LINE FILTER IED D WIDTH LENGTH DEPTH DISTANCE TO IIEAMOTI WELL FOUNDAIIDN PROPERTY UNE MOUNDED D VMTH L;NDTN DEPTH DISTANCE TO NEAREIFI Well. FOUNDAMO PFFMRTY LINE ['1 SFFTAOE RTO ❑DEPTH SITE NUMBER DISTANCE TO NEANEBTI WELL FOVNDAMN PRaPERTy LAZE VG\� sumps 13 Y/Ib1H LENGTH LIEPTH DIBTAIICE TO NEARESTI WELL FO NIDATION PWKMY LNF DISPOSAL PONOS 13 W{DTN LENGTH DEPTH OISTANCF TO NEARE871 WELLFOUNDATION pROPERTy wk - I HERESY CERTIFY THAI I HAVE PREPARED THIS APPUCA7H7N AND THAT THE WORK WRA BE DONE IN ACCORDANCE WITH BAN JOAOUrN COUNTY ORDMANCEO AND STATE LAWS,AND RULED AND REGULATIONS OF THE BIW JDALLUINCOUNTY.HOMEOWNFROA LICENSED AGENTS SIGNATVRECE1 WMI THE FOLLOWING14COMPYTHATINTNEPERFOPMANCE Of TNEN41K FORWIMH TWO POWIT M mKIEO,I SMALL NOT EMPLOY ANY FERWH RA SUCH A MANNER AO TO BECOME MASJECT TO WORKMAN'S COMPENBATIOH IAWs OF CA"FMA.-CONTRAC*OR'B WINO OR (� OU"ONTRACTING MONATURE CERTOES TILE TOLLOYMIGI M CERTIFY TWAT IN THF FEf6OFMANCE OP THE WM FOR 111RCIL TMIB PERMIT IS NMVED.i SMALL EMPLOY PERBONB BUBJECT TO p WORIMAN'B COMPENSATIONLLAWWSSOF CALIFORNIA.' THB APPLICANT MUST CALL 24 MOUE!IN ADVANCE FOR ALL MWAFED I IN,S.�PECTIONS.COMPLETE DRAWING BELLOW. WOHEO X / TITLE:�T V.I r c 1 I i o m g 6 e r� GATE: C? +� PLAT"M SJRAW TO BCALO SCALE •I,�200 . 1.NAMES OF BT7RET0 OR ROADS NEAREST TO OR BOUNDING 111 It PRDPERTII. _- A.LOCATION OF HOUBE BEWAOE DIR{pOBAI SYSTEM OR PROPOSED 7.OUTLINE OF TIE PROPERTY,WITH DIMEWS OMS AND NORTM ONDC7ION. EXPANSION OF SEWAGE DISPOSAL BYOFvj. ,{l 7.OIMENSIONEO oIRl1ME9 AND LOCATION OF ALL FXIBTRIO AND PROPOIEO STIV1C701O6, i.LOCATION IOP VVEILf WIFRRIN RADION OF ONE HUNDRED FIT7YFT.ON 1NCLUDINO COVERED AREA@ SUCH AS PATMIL DRIVEWAYS,AND WALRB. THE PRDIEILTY OR ADJOINING PROPERTY. I�� .. . ..... � � Tai ... n . q i 199$..... ~~ Rd�M HHrEni H.nuTvloss �'rnn H rvis r� Parc I�o��s .as sh wry .. L'. _ .. . ... - ,.... ..... R� : . Lam. ... FOR DEPARTMENT USE ONLY AMK:ATIUN ACCEPTED BY C __, DATEt ArLE'A•z eL_ �y/ )ANI,RT On SUMP MBTECTIORl By L ATE f I ,--.FINAL INSPECTIONS DATE-� p AMTIONALCOMMENTS: (f f f 9lumiwahrf 4" e,,e,- ole 5 f& ;jib" I,,, ACCeVNRMO ONLY: IVDA FACS PE CODE FEE INTO AMOUNT ROMITED CILICIVIC IIECBVm BY DATE LIR I PBIMT NUBM91 INIVOICE/ a a T'0 o L10321 Pub.HBal1h SoTv.•Ermro,174(31)6}