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T"V�D APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ` ENVIRONMENTAL HEALTH DIVISION P.O.BOX 3811,448 N.SAN JOAQUIN ST.,STOCKTON,CA 28201-0388 {208)488.3420 NON-REFUNDABLE PERIEIT EXPIRES 1 YEAR FROM GATE ISSUED OkWiste In TrgUsatsl Application is hereby made to the Can Joaquin County for a permit to construct and/or Install the work described. This application Is made in compliance with San Joaquin County Development Title, Chapter 9-110.3 and the Standards of San Joaquin County Public Health SerWces, Environmental Health Division. Job Address/or APNN a `r�3 City Lot Of's S�A�ckf Owner's Name r ress��Q1mC1 contractor s�a-C, .� S.rT c Addresses 5 1 �ti4�o.n Va�rLicN_,9Qa-LZ,�_,Phona.& _J2�9 Sub Contractor Address LfeN Phone TYPE OF SEPM WOR%: NEW INiITALLATIG*I 1 REPAIRIADDITION W- DESTRUCTION I i PERE TEHTill I I Haw many (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 204 FEET OF BUILDING.) Land Use Applinties! installation will serve: Residence_ Commercial I Other_ Number of living unftar_ Number of badroomss— Number of emplaynes: character of of soft to a depth of 3 loot:CIA-e Pit/Bump Boil Character. ( 44,r l Water Table Aapth r0_iZ�- SEPucj..:—aKMILAHE TRAP L] TYPE/Mfg Capacl ty i =C:a No. compartnmte,,,�„---, PND TREATMENT PLANT l 1 Distance to nearest: Well Foundation Property Line LIFT STATION[] Size—Type of Pump Sand lull Separator (enclosed system) LEACHIND UNE - 4E.. No. R length of Lines 41) Distance to Nearest: WeILT Z7r Foundetfon,�!_Property LI-- FILTER 8E0 [1 Width Length Depth mcf �c� Weil Foundation Property Line MOUNDED 11 Width Length Depth •�" Well Foundation Property Lloe W SEEPAGE PITS Jr Depth_-"Size �a Hugber_,,3_ ° Well ylFoundatiat_ Property Linkq-30 Z SUMP$ [I Width Length Depth '� �Yall aO��Foundatian Property line : DISPOSAL PONDS E1 Width Length Depth Weil Foundation_ . Property Llne Q I hereby certify that i have prepared this application and that the work wilt be done In accordance with.San Joaquin County Ordfruness V, and State Laws, and Rulas and Regulations of the San Joaquin County. Now owner or Ifcensed agent's signature certifies the following t "t certify that in the performance of the work for which this permit is Issued, I shall not waptoy any person in such a manner aa - 5 to becom subject to workrmn's eampensetfon laws of Cslifornis.m Contractor's hiring or subcontracting signature certifies the' following: 11 certify that in the performance of the work for which this permit is lasued, 1 shalt employ persons subject to workman's- - compensation taus of California." The applinst mush Ball 2/4J hours In Id for OR rsgsbe h aapmetlsm. Complete drawing below. Signed x �/l�j= sTitle: Date: 4!- 7-95- PLOT -95PLOT PLAN (Draw to Scale) Scala to 1. Noma of streets or roads nearest to or bounding the property. 4. Location of house sewage disposal system or 2. Outtina of the property, with dimensions and North direction. proposedexpansion of sewage disposal systems. 3. .Dlnensioned outllnes end location of all existing and proposed 5. Location of wells within radius of 150 ft. an structures, including covered areae such as patios, driveways, the property or sdJoining property. ' and walks. - -S't'/encs k ` OF, �J f • , PAIVACEN s E 499 OUP ry NM NTA i1E LTFf FOR DEPARTMENT UBE ONLY Application Accepted by_ !A/i'..r�- _ Date: 7 S Area: tl. Tank, Pit or Sump inspection by Date / I_ Final Inspection by Date 5/ /Q .0 Addlt(onat casements: n.l .,J r 2o-19` ! /LJ -c wa f�s ACCOUNT(HO SNIP: AIDS FAC! PE E CODE FEE INFO AJWUNT REMITTED E SH "Coll"HT GATE iR!PERMI[MUIIHER IHW6ICE N __Ul 711q. / 3 + OdB