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APPLICATION FOR LIBUIO WASTE PERMIT y <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH.SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 386,446 N.SAN JOAQUIN ST.,STOCKTON,CA 96201-0389 <br /> (209)468.3420 <br /> 110RFREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ` <br /> (CDmPbu in Tri{Ii4AU) <br /> APFUCATRNI IS HEREBY MADE TD THE SAN JOAUVIN COUNTY FOR A PERMIT TO CONSTRUCT ANO109 INSTALL THE WORK I ESCMBED.TRIS APPLICATION IS MATE IN-OMPLIAICE.WITH SAN <br /> JOADLIIN COUNTY'DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDAROS OF SAN JOADUIN COVNTY PLIBLIC HEALTH SERVICE]ENVIRONMENTAL HEALTH—N. <br /> a JOB ADDIIESSOR APNi� J CT' p ��/"�" LOT B17F �/'+G✓ <br /> OWNER'S NAME .ICJ/Ut.Y ��F C DRESS <br /> CON"TRAGEOR �,/I / '/ /r�i ADDRESS ^7/1 �` PHONE <br /> BUS LOI.TRACTOR• Z/JZ`/ ��-+� `_ ADDILESS�z/L/ y�T,T,=//-n�1CA P10NE � <br /> TYPE OF SEPTIC WORK: NEW INSTALATNON❑ AEPNRJAObiTON D11MUCTION❑ <br /> NO SEPTIC SYSTEM PERMTTTED IF RIIBJC SEWER IS AVMLAUE WTTHN 200 FEET OF BVKDING.1 Pp+c T-11-1 I I HOW MANY <br /> APFW.— <br /> INSTALLATION WILL BSNVE: RESIDENCE% COMMERCIAL 13 OTHER O <br /> NoI SHIR OF WINS KIAT.:_�_NINSTII OF BEOROOME._1 _AFLEIA861 OF EMPLOYEEI: <br /> CHARACTER OF SOIL TO A DEPTH—I FEET: _��U R*UMP SOIL CHARACT FH: WATER TABLE DEPTH <br /> SEPTICTANII-J <br /> UO L"l TRAP LTYPFJWG CAPACITY No COMPARTMENTS <br /> RLN TREATMENT PLANT I-]DISTANCE M I EAIiIT: WELL FOUNDATION PROPERTY UNE <br /> LIFT STATION 0�-SIZE TYPE DF PMSP �+• SAND OIL SEPARATOR wicwsm SYSTEM ''}�� _ <br /> L---LIN qE NO.8 LENGTH OF LINES /J!�'�"j/ r DISTANCE TO NEAMM:WE11j�L�rFOLRRIATIONIJHE <br /> RLM SED LLJ VADTH LFNOTk DEPTH DISTMICE TO NFA/[ST:HELL FOUNDATION PRDFERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PIDPENTY LANE �C•` <br /> SEEPAGE RTS ❑DEPTH SUE NVMOEA DISTANCE TO NEAREST:WEAL POUNDATIUN PROPER'r UNE V` <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WSJ. FOUNDAM14 PROPERTY UNE <br /> v <br /> DIf.MSAL PONDS 0 OUTGRIP LMNGi'N D[PTM [STANCE To NEAREST:WELL_FOUNDATIOk PROPERTY UNE f <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL SE DONE IN ACCORDANCE WITH SAN JOADUN COUNTY ORDINANCES AND STATE LAWS.AND FULES 1' <br /> ANOREOVLATIONSOFTHESANJOAOUINCOUNTY,HOME OVMEROR UCENSEDAGENT'S SIGNATURE CERTIFlE67NC FOLLOWNO:'I CERTIFY THAT INTHE PEPS'OFMANCEOFTHEWOIR FORWHICH <br /> THIS PERMR IS ISSUED.I SHALL NOT EMPLOY ANY PERSON N SVCS A MANNER AS TO BECOME—FLT TO WORKMAN'S COMPENSATION LAWS Of CALIFORNIA.-CONTRACTOR'S HINNG OR <br /> 50DCOHTRAC'TNG SKINATU E CERTNES THE fOLLOWM:I CERTIFY THAT N THE PEFIFORMANCE Of THE VVIR FOR WHICH TIIIS PERMIT IS ISSKIED,I SHALL EMPLOY PERSONS SVBJECT To U <br /> WORMAN'S COMPENSATION!LAWS OF CALIFORNIA.'YHE APPLICANT MLMT CALL.—URS IN ADVANCE FOR ALL REOWIRED NSM TTIONS.COMPETE DRAWiNO/B�ELIOW' //ys� <br /> STONED% TiL- TITLE: _I ��/9i•'.+•CiGari. DATE: 6-/j! / <br /> PLOT PLAN DAnAW TO SCALE{SCALE <br /> T.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY_ T 4.LOCATION OF HOUSE SEWAGE U18ROSAL SYSTEM OR PROPOSED <br /> 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DETECTION. EXPANSION OF SEWADE DISPOSAL SYSTEMS. <br /> J.DIMENSIONED OUTLINES AND LOCATION OF ALL TJKISTND AND PROPOSED STRUCTURES S.tACAT10N OF WELLS WrtMN MIND S:OF(HIE HVNpED FIF IV FT.uN <br /> NCLIIDNO COVERED AREAS SUCH A9 PATIOS,DRIVEWAYS,AND WALKS. THE PIOPERTY OR ADJOINING FHOPEM1FY, <br /> .... .. -'e--� <br /> c�s�•�d4.s�' Al�� � <br /> r <br /> I . <br /> $ x ,uT,Nrrl v JdR6EA�� <br /> kU�� ,s• � I �� 1 <br /> :......a. .... - ar <br /> SQ µceYG 4 <br /> k <br /> �rY -;a 4 <br /> Ji�N.2 Q 19$ki .. ..... I� <br /> ... . <br /> :,*IJCIA(]U11VY`LiY?t"ti'�.v.. - <br /> pE-JBLIC HEAT_ i 8F9Vl'; <br /> POA DEPARTMENT USE ONLY Q <br /> AFRICATIDN ACCEPTED BY / 1� DATE: �Q 1 AREA: 7— <br /> Cja� <br /> TANK,PITORBUMPINSPECTION BV DATE i ( IWAL•INSKCTION By j,y.l DATE <br /> ADDIT INACOMMENTS: yy_i'�J�' '�L OK1•]L) •�"✓� - �_�' "L'�l� <br /> ACGOuNONO ONLY: AID. FAC. <br /> PE CODE F- AAOUNT REMfiTFI NEC ICAEH RE>:BVFD■Y DATE 6R 7 PF)WMT NUMRBI iNYO10E <br />