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APPLICATION FOR LIOUIO WASTE PERMIT JOAQUIN COUNTY PUBLIC HEALTH SERVICES D ENVIRONMENTAL HEALTH DIVISION "� O 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DAZE ISSUED (CampItte In Tr IpRtBlt) ARK:ATION 19 NFRERV MADE TO THE SAN"AOVIN COUNTY FOR A PERMIT TD CONSTRICT ANDNR INRIAI I THE WORK UFACiSRED. T1R8 AR'UCATION IS MAUF IN COMPLIANCE WITH SAN P JOAOUN COUNTY DEVELOPMENT TFTLE.CHAPTER 8-1110.3 AND THE BT-A{N,OARDe�O{F BAN JOAOUM COUNTY PUBLIC NEKTN SE1RVICES.ENVS D MAfNTAL HEALTH DIVISION. C.. 1 1 1. C CITY /\L/t•�' �V LOT SIIf Joe ADORESS/OR API/ S -, 1 o(J ApDREBB F7/ 1•-- PF10NE,}� I' LT • C>< OWNFR'B NAME 4 n "~- SS UCS / PFIONE y/1� �z CONTRACTOR E"`-G A�� 1(�I� �n, sue CONTRACTOR ��•�Yt - TYPE OF SEPTIC WORK-. NEW INSTALLATMI)Pc.. REPAIMADMTION❑ DESTRUCTION❑ NO SEPTIC SYSTEM RRMITTED K PVSLC SEWER ISAVAILABLE WITHN I00 FEET OF BUILDING-) FERC TESTIH I 1 HOW MANY APPSstw.B 7 �v- J 1NBT AlLATON WIIL 6—M, RESIDENCE 11COMMEIICIAL* OTHER❑�' //• S4 it MUMSER OF IIMPLOYFEI: NUM11N1 OF VINO UMTS: MVMS[R OF BEM100MS: CHARACTER OF SON TO A DEPTH OF 3 ETTA I/ /SUMO SON.CHARACTER: WATER TABU DEPTH Ar / ❑TYPfMTO 1 -PYNX -1-�`T L- CMACfTY .-1, -n(' NO.COMPARTMENTS .-+1 .tFITIC TANK/o1USE T11M n r PIG TREATMFNT PUNT❑ MSTANCE TO MEANEST: WELL /�0 FOUNDATION ?tC • PROPERTY UNE �\ UFT STATION Cl BRE TYPE OF PUMP $AEW OIL SEPARATOR ItWLORKD SYSTEM] LEACHING LINE ❑ NO.$LENGTH OF LME/ DIATANCE TO NEAREST'WELL FOU DATION RIOMRTY TNF FOUNDATION /C.)0 ' PROPERTY LINE FILTER am • • LENGTH_I DEPTHS'k , DISTANCE TO NEAREST:WELL C l-. _ MOIMDrD ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE S[rYAGE FITS ❑DEPTH SIZE NUMBER MSTANCE TO NEAKEST:WILLFOUNDATION PROPERTY LINE SUM" ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LME DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREBT:WELLFOUNDATION PROPERTY LME I"FIERY CFRTKY THAT 1 HAVE RIFPARTn TICS ARtICATON AND THAT TIIF WORK WIV BF VOM M ACCORDANCE WUH SAN ICAOUIN COUNTY OROMANCIA AND STATE LAWR,AIT RIA I' AND REGULATIONS OF THE SAN JOAOUIN COUNTY.(((H��OME OWNER OR LICENSED AOENT'S RONAILI IF CERTIFIES"If EDIT OWIHG:'I CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WIIFCII THIR PERMIT IS ISSUED.1 SHALL NOT EMPLOY A EON M SUCH A MANNER AN TO RFCOME SUBJECT TO WORKMAN'S COMPENBATMN LAWS OF CALIFOIMBA.' CONTRACTOR'S MRNO OR RVB CONT RACTINO BONATU ERTKIEB TIRE FO OWING:'I CERTIFY TI/ATM TINE PFREORMA CF OF THE WANK FOR WH$CH IVIS RYRMTT IS IA"MD.1/HAIL FMriOV PERSONS SUBJECT TO WORKMAN'S NMT U OF CALWID. TME APPLICANT MUST CALL H IOW M 080W.ADVANCE FOR ALL REOI/1ED INSPECTION/. COMPLETE DRAWING DEW4 Q -- '1 r r! 7 L'P` TITLE: //iLa� DATE: �. ROT RAN BMUW TO SCALE]SCALE It 1.NAMES OF ITREETS OR ROAD"MARFBT TO OR BOVNDINO TIIF RKIPFRTY- 4.LOCATION OF MORE SEWAOE MSPORAL SYSTEM OR PROPOSED I.ONTLNIE OF THE PRORRfY,WITH DIMENSIONS AND NORTH DIRECTION. FKPANSION OF KEW Of M@F00AL SYSTEM'. �.DIMENRIONFD OUTLNES AND LOCATION OF ALL E%IRTINO AND Pnot oSED"TNUCTUR<B, S.lOCAI ON OF WFV.B VVTT/III gADR1B OF ONE HUNDRED IIFTY R.ON INCLUDING COVERED MEAS SUCH AS PATIOS,DRIVEWAYS.AND WALKS. THE R10PTnTY on AOJONING PROPf STY. rI\ ��ACC 121 Pin` L,.v IG,w (2o c c� •�, 1• f Jyl I- k.•'�Il.1 .te � 12 <'J�.ICe.IL:T ._7 v 1 RECEIVED DEC 1419 WIN JOAOUIN COUNIY PUBUC HEALTH eFi1VIC@B - ENVIRONMENTAL H fH f�IV FOR Dry,"MENT UBE ONLY ARliGATIOH ACI'F/'tED DY � DATE:� I/%J�y,''Y APEA• TANK,PIT OR BUMP NSI'ECTWH BY / ��//O / ' `D/ATT EE I`I FINAL]NSFf CITION'BY4(!R6EE�')4;4 DAATT.{E.�/?L12 /1/Z �'/�F`� " ADDHIONALCOMMENTS:F/I /ti �� /�/C��`� /✓/7/7 O�` �UI of &Y— /� �c/I S /7 �'I/C_I CJ� -2c7 •YG•^� �COLNTNO ONLY AOI FACE 111111 K CODE FQ INFO IIID VNT"CMUTED C HEC"ICASH PI CERIED BY DAT SR/F9E1ST MIM$FJ1 INVOICE ,�a �;� c 'q `6 6,705Zf �� C o Pub.Health S'ry Envlro.174(3198)