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;..._ _-- .• ._ -- -__.____. • —.-- -� APPLICATION FOR 1.10010 WASTE PEI;M':..° SAN JOAQUIN COUNTY'PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 9520 Yw f-�! (209) 468-3420 -� P1 0119-REFUNDABLE PERMIT EXPIRES I YEAR FROM RATE ISSUED pIOry �ggg lcomplllB In Trlpllestll I�[tiG `I i APPLICATIONMADE IB HEREBY ADE TO TSAN JOAOUIN COUNTY FOR A PERMIT TO CoNBTnUCT AND/OR INSTALL THE WO PK mcnI11ED. THIS A CATN IS MAO I I OMPUANCE WITH BAN JOAQUIN COUNTY DEWLOPME I�T nt.CHApun B-1h110.3 AND THE STANDAROB OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,fNVInDNM�N }N I "ION ,,,AD,.,,.,APNr__-Ar �i i_—V9 V-o�,_-ttse pe mif 99-8 CITY._LDcl r_pT11dVCUU�;�}1�1��p�is OT8f1E i5D' OwHER'SNAME[7C_r+TD rt.s4S .r Pl'1'tir'_ l�ltl'�/_ADnnEeBl��Qf�5f, St HeIU_ �Q, G'?q_ - -��-------- PITON 707 31D eoRrrluclon�}'1DDJ� EAl?tJ� TeC.hnolOgICSAmm.,9 FrAnb 4'1 eiL7r-c1 S'be-I SkLWiL PHONE 2.3+-45 BUncoNTRACTOR F d rl ADOSE8S ll!2Hammond uc#099172 PHGN D RD -a TYPE OF SEPTIC WORK: NEW INITALLATION RLTAIRIADDITION ❑ DESTRUCTION fNO SEPTIC BYSTEM P£WMITTEO 1F PUBLIC SEWER 18 AVAILABLE WrtNlN 200 FEET OF BUILD(NO.) PMC TESTId L I NOW MANY I F-� - _ ..AppNMBOn/ . INSTALLATION WILL SERVE: RESIDENCE© COMMEncin OTMEn 0 N11AIS ER OF LIVING UNITS:, N _ HUNKER OF tETM100M1, NUMEE71 tlF.EMaLOYEEI:_35�affer yea�es CHARACTEn OF BOIL TO A DEPTH OF 7 FEET: L PITlBUMP BOIL CHARACTER! WATER TABLE DEPT -r'-e--}- i i SEPTIC TANKN1r1EJllE TRAP ❑TYPElMFO CAPACITY NO.COMPARTMENTS "0""TT.AEHT PLANT❑ 1118TANCE TO NEMEST: WELL FOUNDATION PWOPERTY LINE UFT STATION❑ SIZE TYPE OF PUMP BAND OIL SEPARATOR(ENCLOSED SYSTEM) 1_ LEACHING LINE ❑ NO.•LENgTH OF UNEB DISTANCE TO NEAnESTt WELL FOUNDATION PROPERTY"HE FILTER SED ❑WIDTH LENGTH DEPTH D1ITTANC£TO NEARMSTt WELL FOUNDATION PnOP£RTY LINE MOUNDED ❑WIDTH LENGTH DEPTH D18TANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE y BEEPAOE PITS ❑DEPTH SIZE NUMBER DISTANCE TO NEAAEBTI WELL FOUNDATION PnOPEF"LINE BUMPS ❑WIDTH LfNOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION F?IOPERTY UNE i DISPOSAL POND! ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREBTI WELL FOUNDATION PROPERTY LINE I HERESY CERTIFY THAT I HAVE PREPARED 11118 APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY OAWNA14CER AND STATE LAWS,AND RULES AND REGULATIONS OF TILE BAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIE B THE FOLLO WING I'I CERTIFY THAT IN TME Pf FTFORMANCE OF THE WORK EOR WHICH THte PERMIT IN ISSUED,18f1All NOT EMPLOY ANY PERSON IN SUCH A MANNER AN TO BECOME SUBJECT TO WORKMAN'•COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIIVNO OR 81111-CONTRACTING BtGHl1TURE CERTIFIER THE FOlLOW1NG1 11 CETTTIFY THAT IN THE PERFORMANCE OF THE WOf K FOR VAIM11 TMIS PERMIT IB ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LLAWW/S�OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HODU IN ADVANCE FOR ALL REQUIRED N INETE/PECTIONS. COMPLDRAWINO BELOW. t` . SIGNED X TITLE:.--? t[1 + 'a H 4 V_t r-_-_-._--DATE: PLOT PLAN(DRAW TO SCALEI SCALE_ / -_ _ 'to K�2Dp V. 1. NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PAOPEITTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED - 2. OUTUNE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DIBPOSAL SYSTEMS. I G. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WWRIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUIXNG COVERED AREAS SUCH A8 PATIOS DRIVtWAYS,AND,WAUCe, THE PROPERTY OR ADJOINING P110PERTY. ., i .. .. Fl ..... . . ...... as' SKS :.fur ..