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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)4683420 <br /> 11 NON-REFUNDABLE PERMIT UNNES 1 YEAR FROM DATE ISSUED <br /> (OIiaPYTa In TrIPBnErI <br /> APPLICATION 19 HERESY MADE TO THE SAN JOAQUIN COUNTY FOR A PERM"TO CONSTRUCT ANDAA NISTAL THE WORK DESC W BED. THIS AMXATON IS MADE IN COMMANC!'KITH BAN <br /> JDAd1IN COUNTY DEVELOPMENT TRU:,CHAPTER 9-1110.3 AND THE STANDARDS OF BAN ,DACAMN COUNTY I,LSU:HEALTH SERWCEB.ENVIRDNST Al.HEALTH OWING". <br /> JOB ADDIREneAOq WNRG n-(M O'l,{ny p��• ?f,� ZZ-T. (� ��yyy ,e �y -{ cm STCG..�TU N LOT SIZE 2U F}CL�., <br /> OYAVER'SNAME�_R_� vER'NON 1366 T ADDRESS "EAV(/ N. YL%ZZI FR10NE p31- L4-73& <br /> DOMTnAcian PAD02JALD * 'SYiOR-T ADDRESS +-'45 L+IL.D(,eW l-hl LCA 7325013 PH014E-gj -0'-10(7 <br /> OUR CONTRACTOR ADDRESS pI M. THIONE <br /> TYPE OF IEPNC WORK: MLW INiiAl1AT10M ❑ gEPAIRIADOITOM p bRAIMUCTON ❑ <br /> IND SEPTIC SYSTEM PERNRTTM IF MOUC SEWER 18 AVA.ABLL WITHIN]OO FEET OF BUILDING.) FERC TESTHI I I HOW MANY <br /> T- APPYsden I� <br /> INSTALLATION MUL ll N - RESIDENCE® COMMERCIAL ❑ OTHER RY Q F -C 6 <br /> NIMBEL OF LMNO UMTS: NVIASER OF BEDIOOMS: NUMBER OF W" : <br /> C L-A Y r <br /> CHARACTER OP SOIL TO A DEPTH OF]FEET:_ PRfeVMP BOR CHARACTFP: Ln P FYRr SAW ATER TABLE DEPtIt_I <J ' N <br /> SEPTIC TANNUORTASE TMP ❑TMP -G CAPACRY NO.COMPARTMENTS <br /> PRO TREATMENT FLAW El DISTANCE TO MEAR>VT: WELL FOUNDATION PROPERTY 1NE <br /> RIFT STAMM 11 IRF TYFE OF PRIMP SAND OIL SEPARATOR(ENCLOSED SYSTEMI/_ <br /> LEACHING UNE ® NO.A IENOTH OF LINES I- 40' DISTANCE TO MEANEST:WELL UJQ/ fOUNDATON 10 PROPERTY LME 3Okc_fe5 <br /> FILTER IID ❑YADTH LEMM— DEPTH DISTANCE TO NEAREST:WEUL MVP:OATON PRDPERTY UNE [' <br /> MOUNDED ❑WIDTH LENGTH=—DEPTH DISTANCE M NEAREST:WILL FOJNDATON ROPERTY UNE `(�C <br /> SEERACB RTS IOp Z <br /> DEI'M SJ WE��'NUMBER`�dBTANCF TO NEAREST:WELL 100 FOINOATON 100 FROFERYINE 3 OL C.TC-5 <br /> 11 W <br /> aw" IDTH LMGM COMM DISTANCE TO NEAREST:WELL _MUNDATION FND E LINE <br /> DISPOSAI PONDS 0YJIDTH UENOTN _bEPTH DISTANCE TO NEAREST:WELL__FOUNDATION PROPERTY UNE <br /> I HERESY CERTIFY THAT I HAVE PREPARED THIS AP ATION ANO THAT THE WOR(HALL BE OME IN ACCORDANCE WITH GAN JOAWIN COUNTY ORDINANCES AND STATE LAWS,AND PLUS <br /> AND REGULATIONS OF THE SAN JOAOUIN COUNTY.NOME OWNER OR LKLiISEO AOMI"'B SIGNATURE CERTIFIER THE TOILOVANO:I CERTUYTHAT RI THE PERMAIMANCE OF THE WOAR FORYABC" <br /> THIS FERJR IS ISSUED.1 SHALL NOT M"V ANY PER90N N SUCH A MANNER AS TO MEDIAE SUB.IECT M VWRSRMAH.•6 COMRNSATION LA"OF CA FORSA.• d1MRACTOWS HIISIIS OR <br /> SU NTAACTINO GONATURE CERTIRES THE FOLLOWING:'I CERTIFY THAT IN THE FfMRC MANCE OF TILE WOK FOR W WCN THIS PERMIT IS ISSUED.I SHALL MI'OY RRBDNS BUSIECT TO <br /> WDR(MAN'S C <br /> O <br /> MPE <br /> NSATION UW.S,UOFF CALIFORNIA.- THE APPLICANT MW't CALL lI HOURS IN ADVANCE FOR ALL IU�wwwoo mooP m". COMPLETE dNWINE BLOW, <br /> :ONED X G-fJi�J ALV R'✓R TITLE:_ V+/N\EW`C-TDI� DATE: O`Ji Z�J L f1 ID <br /> ROT PLAN IORAW TO SCALLS:SCALE 1e LL <br /> 1. RAISES OF STREFTI OR ROADS NEAREST TO OR R RANO THE PROK[ . A. LOCATION OF HOUSE SEWAGE DISMOAL SYSTEM OR PROPOSED <br /> }. WTLINE OF THE FTIOF£RTV,WRH DIMEMSONI AND NORTH DIRECTION. EXPMSON OF IEYVAGE DNMTRJAL SYITENIS. <br /> 3. DIMENSIONED OUTLINER AND LOCATION OF ALL EXIBTINO AND PIOMSEO aTgVCTUPES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLLOIMO COVERED AREAS SUCH AS PATIOS,DRI E AYB.AND WARS. THE PROPEiRY OR AbJOOfINO PRDPErtTY. <br /> .. . ...... :.. A Li.�. <br /> . <br /> ...:. <br /> a�F <br /> : ..: i . <br /> . . ... ..:. . .. . <br /> ._......:_....................,....................:.......... :Ay.. .... ............................. <br /> .........:.. } <br /> �.......i......`.......i......'......:......:.......'......`.. ..... <br /> L <br /> Z '� <br /> .........,.__........,.__..:............:....1............................e............e. ._.. <br /> .....:.......:.......`.... . <br /> F <br /> �..:......:....�..........:.....:... . .. ..... .... ...... ... .. .. <br /> ...........:.... <br /> € _ <br /> i . <br /> . . <br /> ... .......... .4D PAlCIV► <br /> ■ �.,.. .� w.r .�(,;. . .......'.._ .. b... . . N7 <br /> . . .:. <br /> .. <br /> . .. �tAY <br /> p. <br /> .. <br /> . <br /> .. ... _........<. . <br /> ......< .. ...... . . .... ...o...... . . ....: . <br /> �x1Y�bAOWN COUNTY... '. .... <br /> PLIM <br /> IRONA'(EN7'AL NFA4TN8F3NIL - : ... <br /> �NCALIEAI.IT7 prylBpN ;. <br /> ... ....: . ... _.'.��..i _.. ..'..�_ '. . ^ ............ .......... .t .. ....... ......:........... ........ <br />