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APPLICATION FOR LIO1110 WASTE PERMIT <br /> j SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> MOWREFUNDAM PERMIT EXPIRES 1 YEAR FROM RATE ISSUED <br /> IC.IRpI.t.in Trlpbul.1 <br /> APPLICATION 19 HEREBY MADE TO THE SAH JOAOUIN COUNTY FOR A RERNR TO CONSTRUCT ANWOR INSTALLTHE WORK OEScRIRED,THIS APPLICATION 1S MADE IN COMPIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1710.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY V VSUC HEALTH SERVICES,ENVIRONMENTAL HEALTH btVIGION. <br /> Jt } .lo6 AooREaemR AFkr "9-' '15 gl'4e<G _ cFrY l_+ni*.y.=' _ LOT BrzE';4Y– <br /> OWNER'R NAME f_iLTA_ 'X=nl._�f2T.�,n ADDREss / PHONE„_� 'j-�-/G.S-� <br /> CONTRACTOR /.,,,I'o,'l 7/hf � 4 ADDRESS ti'JPt� UAB uc. 'S PHONE 4-c(3�` <br /> { <br /> Ft <br /> SUBCONTRACTOR RDDRESSOOI uct PROFIT <br /> F TYPE OF SEPTIC WORN: xLW INATALLATIDM❑ naN Ja DEA--v ON CI <br /> EE• IND SEPTIC SYSTEM FERMTRED IF PUEUC SEWER IS AVNVALE WITHIN 200 FEET OF 6URDiNU.1 PB1C TESTIrI l]HOW MAMY <br /> T^ 11AppSe.Sen <br /> Ems+ INSTALLATION WILL SERVE MSIDENCEI��,,^L COMMERCIAL❑ OTHER❑ <br /> y NUMBER OF UVINO UNITS: I M Nw-un OF.—.*Ms: ;_1 NUMBER OF EMR YEE6: <br /> IyFI �1 CHARACTER OF BOIL TO A DEPTH OFr�31 FEET: RR RIIR <br /> TISUMP SOCHAER: WATER TARLE DEPT <br /> H <br /> SEFTLC TANKIOREASE TMP MT�TYP ro 1ocr^3 1n41 CAPACN'Y NO.coMPA"TMENTB <br /> PRD TRTAtTATHT PLANT❑ DISTANCE TO NEAREST; WEST FOUNDATION PROPERTY UNE <br /> LIFT STATION❑ fl-IZE TYPE OF RUMP SAND OIL SEPARATOR IENCLORED SYSTEMI <br /> ,"NO ONE M NO.A LENOTH OF ONES �' �� .L14 R�1I7181 fr'DI.TANOE TO NEAREST:WELL irk' r FOUNDATION '0} PROI'ERl"l ONE <br /> FILTER B® ❑MOTH LFNOTH DEPTH dSTANCE TO NEAREST:WFLL FOUNDATION PKIPERTY UNE <br /> r MOUNDED ❑WfOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY ON 1 <br /> BEEPAGE RTS Q'OLPTH •fS 1 GLZE�_HUMBER_DISTANCE TO NEARESTo WEIL_JL�0^FOUNDATION 41;7' PROPERTY UNE t _ 1 <br /> SUMPS ❑W TH UKGTN DEPTH DISTANCE TO NEAREST!WELL FOUNDATION POPERTY ONE F`�1 <br /> DISPOSAL PONDS ❑WIDTH LENUTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> tiT I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APP.ICATION AND THAT THE WOW.WILL RE DONE IN ACCOADA CE WITH SAN—OWN COUNTY ORDINANCES AND STATE LAWN,AND RULED <br /> AND REOULATKONS OF THE BAN NOAOUIN co VNTY.HOME OVMERORUCEH$m AOENT'6 SIGNATURE CEHTIFIEB THE FOLLOWING:'1 CERTIFYTHAT IN THE MPFORPMANCE OF THE WOEK FOR WHICH <br /> THIS PERMIT RS ISSUED,I SHALL NOT EMROY ANY PERSON IN SUCH A MANNER AB TO RECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUFORNIA.'CONTRACTOR'S HINNO OR <br /> SUR.CONTFU CT NO SIGNATURE CERTIFIES THE MUOWING:'1 CERTIFY THAT IN THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS IGOUED.I SHALL EMPLOY PERSONS SUBJECTTO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.'THE APFUCANT MUST CALL M MURIA IN ADVANCE FOR ALL REOLSRED INSPECTIONS.COMPLETE Of AV WGG BE LOWy.� ' <br /> tSIGNED% r�� E� TITLE: mow. DATE: //:�gA-f4; <br /> R <br /> OT PLAN ORPW TO SCALFI SCALE 'M T"`� <br /> 1.HAMX9 OF STREETS OR ROADS NEAREST To OR BOUNDING THE FROPEAT Y. 4.LOCATION OF HOUSE OEWAOE MDpUUAL SYSTEM OR PROPOSED <br /> y =,OUTLINE OF THE PAOPERFY.WR"DEMENSONS AND NORTH DIRECVION. EKFANWON OF 0EWME DUSPOBAL SYST TMS. <br /> DIMENSIONED OUTUNED AND LOCATION OF ALL EAISTINO AND PROPOSED STRUCTURES, 6.LOCATION OF WELLS WITHIN RADWO OF ONE HUNDREP FIFTY ET.ON <br /> INCLUo NO COVERED AREAS SUCH AS PATIO*,DNVEWAVO,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> �. iyv^r <br /> I . <br /> 1�.,.,.. .. .. ... A _ <br /> ..> .. <br /> 1 .. - - .. <br /> ..... .... <br /> ... <br /> O 3 1y x <br /> IL{ F ALN�J uiar ' <br /> r' <br /> — sbt <br /> r� <br /> aup ik r+Erat nL orslSlvl, __. <br /> 3 <br /> ... 5...- [,,... .<...., _ .. .. - <br /> Fc.. a Q W <br /> fA Ar <br /> T�(L� <br /> J."r......... ........... <br /> i ` F FOR DWARTMENT USE ONLY <br /> I ♦ APPLICATION ACCEPTED BY DATE: <br /> TANK,FIT OR SUMP INSPECTION SY PATE—If FINAL INSPECTIONDATE / 112 <br /> AOUMONAL COMMENTS: <br /> rr ACCOUNTING ONLY: AIOA FACT <br /> E <br /> HE CODE FEE INFO AMOUNT ROM1ITEO CHIC ASH RECOVEO BYDATE SR f'T HUMBER INVOICE F <br /> . e °ISS' F/po-Dd I <br /> PLS.Heats Sar ,Enviro.174(3196) <br /> ' �w <br />