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APPLICATIDN FOR 1.111VID WASTE PERMIT ��VT <br /> '/SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES 111 <br /> ENVIRONMENTAL HEAITH DIVISION <br /> P,O. BOX 388,304 EAST WEREER AVENUE,STOCKTON, CA 9SMI-M8 <br /> 1209) 9883420 <br /> NON•IEFUKDABLE PERMIT EXPIRES 1 YEAR FOUR ATE ISSUED <br /> -- �C4STRUEA A Tr 7%INST �k E- <br /> AM'L1CATgN IN IWFLIESV MADE TO THE SAN JOADOM GOUWEY FON A PERMIT 7G CONTTPOCT ANON2R INSTALL THE WDPEC OEBC RISl D. THIS AP'PIJCATSIH IE ADE IN GOMPJANCE WITH SAH <br /> JOAOUIN CouNTY DEVELOPMENT TITtF_cHAF/TER 9.1 11 <br /> O-1 AND THE STANDARDS OF BAN JDAOUIN COUHrY PUBLIC HEALTH BE1R+10ES.ENVRIONMENTAL HEALTH DIVIIAM <br /> AS ADORESBA3K APNY L LOT 81;E <br /> OWNEWEI NAME�L�I l~!]� ICADDRESS <br /> CONTRACTOR _ A 1 AOORERs ._7'x+5 , Cl�'• I�/•i L.,^/3C.3.��PFIDN[ ��-SG_•,�f <br /> MR CONTRACTOR ADDRERB uC0 F}gFJE <br /> TYPE OF SLP'TIO WORK: NEW INSTALLATIG RFIAPAJADDITION ❑ L1FA T'RDCnor❑ <br /> NiO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 16 AVAIULSRE WITHIN 200 FEET CF @llILUNO.I FSK TnTT.i[ I NOW MANY- <br /> INSTALLATION YSTLL BERVE: RESIDENCF Q---e0TAMTFLLAL L..I CTHEM[3 <br /> NLRiER OF LIVING VNITC__._NUMVPP 69 SEUROOM/ -_ NUMEER OF EMM OVESS: <br /> CHARACTER OF SOIL TO A DEPTH OPT 3FFE�EET: IM A!�I�-tF"MSUMP SOIL CHARACTER; WATER TABLE DEPTH <br /> SEPTIC TANIVOEIFASE TRAP Mr?Pv:mFD_C i"A W,y _CAPAmT Y_ r C om`��1 NO.CaMPAIrrmw■ <br /> PKa TRFATLAENT PLANr❑ p/TANC/TO NFANEST: WELL FOUNDATION 5 PROPERTY UNT <br /> UPT STATION❑ SI;E TYPEOF PWIMP RANO OIL SEPARATOR INCLOSED BYSTEN <br /> LI,ACHNG UNE 13 W.A LENGTH OF LINES DISTANCE TO NEARWE <br /> EST" LL_FOUNDATOR PRDFERTY LME 3 <br /> FILTNR Am Q-MDTHIY)L3-i DEPTH . �OfRTAHCE TO HEAWNT:WELL FnUNDAT14N ,r, AROPEIme aw <br /> MOUNDED 1P3�L WIDTH LENDTH DEPTH DISTANCE To NEAREST:WELL _FOUNpATEON PROPe TY LME <br /> SLIPPAGE RTIL-F DEPTH SRF _NURWA DISTANCE TO MAAEBT:WM FOUNDATION PMPFRTY LIFT! <br /> 0WAPS ❑VAOTH LENGTH DEPTH DISTANCE TO NEATEST:wuL FOUNDAT1oN PROPERITE <br /> rY L <br /> DISPOSAL PONDS 11WIOTN LENGTAEVTH <br /> H T . DISTANCE TO NEAREST:WELLY FOVNOATION PROPERTY LINE <br /> I HEREBY CEAYIFY THAT I HAV!nEPAFEO TMS APPLICATION AND THAT THE WORK WILL SE DONE IN ACCORDANCE WITH BAN JOAALRN COUNTY ORDWANCtS AND STATE LAWS,AND RULIB <br /> AFM PEOLA.ATTGNS OF THE BARMAOLAN COUNTY.HOM£OWT.ERORLFCENOW ASEW'S SIGRAru"CERTLFIES TNEIOU.*~:'IC£RTIFYTHATIN THERIERFO NJANC!OF TLE WOIEL FORINMCH <br /> THIS PEFMR Is IIISVED.F BNALL NOT EMPLOY ANY PERSON M SLICH A WANNFK AS TO BECOME OUSJECT TO YMWMAN't COMPENSAl"LAWS OF CAUFOAW.' CONTRACTOR'S HLRMG OR <br /> SLI&COWRACTING SSLNATURE CERTIFTS THE FOLLOWING:'I CERTIFY THAT IN'.TL!PERFORMANCE OF THE WORK FOR VJWH THIS PE.FMIT IS ISB4BD.I SHALL EMPLOY FEASORLS SUBJECT TO <br /> MAKIdAWPCOIIEFlE+SAIjON LAWS OF CALSIORNIA.' THE.EIPEJGAMT MINT CAL+.24 toulu IN AWVFCF PVR ALL 11SOLr1ab OIIPEC'"ONS. COYgETE DRAWING SELGW. <br /> 1l <br /> 61GNE�D� -_J�� DATE: Z- <br /> PLOT PLAN MNAW TO SCALEI SOME eF <br /> 1. NAMES OF STREETS OR ROADS NEARIETT TO OR IOUNDWO YLEE flgPERrY, 4. LOCATION OF HOUSE SEWAGE DISPOSAL BYSTtW OR PROM CM <br /> 2.OUTLINE OF THE PRDEERTY,YNrrN DIMENSIONS AND NORTH IHFFCYK)N, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> D. DIMENBIONEO OLTLINES AND LOCATION OF ALL EXISTING ANO PROM BEO STRUCTURE R, E. LOCATION CF WELLS WFrHM NADILM OF ONE HUNDRED FiTI FT,ON <br /> INCLUOENG COVERED AREAS SUCH At PATIDT.DRBVEWAYS,AND WALKS. THE PROPERTY OR AOEo1Nm ROPENTY. <br /> r <br /> .ae) �.. <br /> 1601 <br /> c i014 <br /> wcier <br /> I ! � E ►� <br /> f lG� a '`' ► 'v <br /> s <br /> Idxbl' <br /> I � ; <br /> D it I VE <br /> . WA <br /> a 1 <br /> P M [TIT List ONLY <br /> A14LICATION ACCEPT EG SV `� DATE- APER: <br /> TANK.NIT OR SOINP TNSPECTION SY DATE f FINAL INSPECTION IY DATE�� <br /> AGOITIOHA!C?MMENTS: <br /> ACCOUNTTMO aNLY� .VON FALI <br /> IF-PE <br /> COOS FEE INFO AMOUNT REMITTED CNEC KE BN RE iD SY GATE IR f FSISNIT MUINM <br /> R IIdCE/,000k <br /> �fD D 7 (o ra 8 1 <br /> 1-7014,71 <br />