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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAw JOAQUIN COUNTY PUBLIC HEALTSb'$VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> NOR'REFUNDARLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (CsmPut/in Trblk/hl <br /> AAVCATION 18 IIEKBY MADE TO THE AAF"AMIN COUNTY FOR A PERMIT TO CONGTTMCT SHEMIN SORAI L THE WOR(DESCRIBED. THIS ADNJCATON R MAGE m COMPLIANCE WITH SAN <br /> "AWN COUNTY DEVELOPMENT TTRL CHAPKR 8-1110.3 AILD TO STANDARDS OF FAN JOACUIN COUNTY MSM HEALTH K CE NV1RD1 MAL MALT"OMSON. <br /> FOR ADOREGSOR / I ' / o lr I,�, CRY LOT WE <br /> OW N-0 NAME A BB Abd j/F <br /> COWIMCTOR AINNEBB L`74 44 <br /> now <br /> SEM CONTRACTOR AOOREne Mo RIDNF <br /> TYPE OF SEPTIC WORK: NEW smaikuAmme ❑ RAAKUAMIM" ❑ DESTRUCTION <br /> 1No sEPTIc BYBIEM RIMITTEOIE R SEWER 1 VARAME WITMN 200 fE"Of NLMFINO.I PltlP TBT1fl l 1 HOW MANY <br /> ANIS{eR I <br /> IN/TIIILATION WILLSERVE: REBOENCE❑ COMMEECI ❑ OTIIFR ❑ <br /> NV M OF UVINO)MTS: NV MOF BEDROOM•- NMHSRE Of MMOYEEF' <br /> CHARACTER OF SOR TO A DEPTH OF 3 FEET: HUMP SON.CHARACTER' WATER TABULAMBR <br /> SEPTIC TANKOEEASE IS AS ❑TYPEMFO cAvI Z M.COMEAMME <br /> MO TREATMENT NANT❑ INSTANCE TO NEMEST: WELL FOUNDATION PIIONmY UNE <br /> 16T STATION❑ BRE TYRE OF DOME SA OIL BE+AMTOR IENCLORED SYSTEMS <br /> LFACRMO ONE ❑ W.S LENOTH OF LINEA DISTANCE TO NEAREST:WELL FOUNDATION- <br /> FILTER RED ❑W11rT112i LENGTH OEPIR, STANCE TO NEAREBI:WELL FOUNDATION PIIDKRry IIHE <br /> MOUNDED ❑�MOTN LENGTH PfN Of E TO REAMBT:WELL FMNOATgN P110KRTY UNE <br /> SMAOE RTS ❑DEPTH WE MIMBER "BY TO NEAREST:WELL FOUNDATION FROMITTY UNE <br /> HIMPA ❑ <br /> MOTH LEND OFPTII DISTANCE NEAREST:WELL FOUNDATION RRONRry UNE <br /> DISPOSAL FONDS ❑MOTO TH DESRI DISTANCE TO ST:WELL FOUNDATION PROFLRry LIME <br /> I HISTRY CERTIFY T14AT I HAVE FRIEPAREd THIS AFT'LICATON AND THAT TIIE WORK WILL BE GONE IN ACCOMA WITH BAN"AMIN COUNTY OKNNANCEB AND STATE)AWA.AND NUI ES <br /> AND REMLAT CNB OF THE SAN.CA06INCOUNTY.MIME OWNEn OR LICENSED AGENTS BMNATUIECURIFIESTHE OWmO:-ICERTIFYTHAT INTRTREKOPMANCl OFTNF WORE lOAW111C11 <br /> TMA PERAR M ISAUED.I/mIMYfIOT EMPLOY ANY ETIEN N M SUCH A MANNER AS TO BECOME SUBJECT TO WORKMA COMEENBATON UW{OF CAINOPMA.' P-OMMCTOR'S HI MOR <br /> son CONTRACTING MATURE CERTIFIES THE FOLLOWING:I CERTIFY THAT M THE PERFORMANCE Of THE WORK FOR H THIS M EMR IB ISSUED.1 SHALL FMNOY FYRSONII AURJECT TO <br /> imanoM 'B COMPS ATTOM LAWS Ofr/CCAALIFM CALIFORNIA.- TAF/MICAANNTID <br /> /MUST CALL 2A HOURS 1N ADVANCE R ALL 11E0 <br /> ANMBPECTON/, COMIM1EIE MAMNO"ROW. <br /> BInNFO% TITLE: DATE'. <br /> F'I NOT PLAN OMW TO SCALA)WALE__-0- <br /> I. <br /> e1. NAMES Of STREETS OR ROADS WAREBT TO OR ROMOINO THE 1110PERTY. 4. LOCATION OF HOUSE lFWAOE 01S10SAL SYSIOA OR NOFOSfO <br /> 2. OUILIW OF 111E N AMY.WITH MMENMONS AND WMH DIRECTION. EXPANSION OF SEW'AOE OMEOBAL SYSTEMS. <br /> T. TXMENAIONFO OUTLINES AND LOCATION OF ALL EXRTNIO ANO FWDDOGED STRUCTURES. S. LOCATION OF WELLS WRHRN RADKMI OF ONE HUNDRED FIFTY FT.ON <br /> IMLUDINO COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADIPO1NSJ0 FTOPERIY. <br /> ACIO <br /> O <br /> cl <br /> O <br /> z <br /> - PUPIJG r'rr 111U'I;J:CI"F <br /> FIJNn, mMt,�rt 11 'Ir I Il i! ll". <br /> FOR OFEARTAIHIT USE ONLY <br /> ATLICATION ACCEPTED Rv �.���(�yD+A�TE `' AREA: /' '///yam <br /> 1wIM."TOR PUMP nISPfCTION BY DATE / / O FIRM INGR pN BY GATE-6 l("1 IT <br /> AMOPONA1.COMMENTS 47 <br /> 1 Pic I Ss,L�191gpyj <br /> ACCOVNIWO DRAY: KEPTFACE LO 7AA <br /> K CODE FEE INTO AMOUNT REMIITEO CMCKEICAH RECEIVED BY DATE ME/P T NOMSFR INVOICE E <br /> � 7s <br /> Pub.NANNh S., EnOm 174(3S*) <br />