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4PPLICATION FOR UOUIO WASTE PERMIT <br /> SAWJOAQUIN COUNTY PUBLIC HEALTH SEr.JICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> RON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (Complete M Triplicate) <br /> APPLICATION IS HEREBY MADE TO THE BAN JOACKIIN COUNFY FOR A PERMIT TO CONSTRUCT ANdOR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH BAN <br /> JOAQUIN COUNTY DEVELOR.IENT TRUE.cNiAr tm 9-1110{.3(�//J/��THE STANDARDS OF GAV.�OAOUIN COUNTY RIBUC HEALTH SERVICES�./fE�.NV1110NMENTAI HEALTH pNB10N. <br /> JOB ADDRE6DNR APNI J�' `� ✓ II /r� (J' 9 CHN Zi/"' LOT SIZE — <br /> MORE <br /> 11*8 NAME <br /> CONTOWNRACTOR ADORES RACTOR )'1 <br /> ADORES MORE <br /> SUB CONTRACTOR <br /> / i(/,T� Ci✓�/% L�'1� I10URE6B/L/ /' ` i''••� •/ }"` Me <br /> � <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ RdAIWADpT10 DESTRUCTION❑ <br /> MC TESTI.I l 1 HOW MANY <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC 6EWER IS AVAILABLE WITHIN 200 FEET OF BUIPANG.) <br /> bpeoADon <br /> INSTALLATION WILL SEINE: RESIDENCE❑ COMMERCIAL ❑ OTHER II T '� <br /> NUMBER OF LIVING UNITe:_ MUM661 OF.F OMS: MUM/SFR OF EMROYQS: /] J Z <br /> RI` TABLEDE <br /> H// WATER TAE PTH <br /> /CIGIIAZ.'T{R OF 601E TO A DEPTH OF J FEET: l (�'. PT/6UMP GOIL CHA/1ACTE <br /> Sf1I1C�TMKIpLEASE TMP ❑TYPF/MF� t47't�. ' IZJcuO_T CMACNY ITC'C� NO.COMPARTMENTS <br /> -�FKO TREATMENT RANT 11 DISTANCE TO NFMEJT: WELL /r� r <br /> MUMATION �O PRORRTY UNE <br /> LIFT STATION❑ SIZE TYPE OF RUMP SAFA OR.SEPARATOR IENCI.OSED SYSTEMI <br /> LEACHING LIME ❑ NO.!LENGTH OF LINES <br /> DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY`UK <br /> — <br /> FILTER SED ❑WIDTH IEN(FTH DEPTH DISTANCE TO NEAREST:WEII. <br /> FOUNDATION FHOPERTY UNE <br /> FOUNDATION PROPERTY UNE <br /> MOUNDED ❑N'IDTN LLNOTH OEPTN' dBTANCE TO NEAREST:VJElE <br /> CNUMBER=pSFANCE TO NEAREST:WELL L:� yFOUNOATKIN /'^'•) POOEERFV UNE <br /> eFE/AOF RTS i1..l OEPTH�SRE <br /> DUMry / [I WIDTH IEFIDTM DEPTH DISTANCE TO NEAREST:WELL FOUNDATION p1M)PERry UNE <br /> DISPOSAL PONDS ❑WIDTH t SORA DEPTH - DUFFANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> NANCEe AND STATE LAWS,ANO RUIEe <br /> I HEREBY CENFIFY THAT I HAVE PREPARED THIB APPLATIO <br /> ICN AND THAT THE WORE WILL BE DONE IN ACCORDANCEWRFH BAN A <br /> JO0111N COUNTY ORd <br /> AND REGULATIONS OF THE BAN JOAQUIN COVN17f.HOME OWNER ORUCENBEO AGENT'S MONATUR CERTIFIES THE FOLLOWINO:-I CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FORWIIICN <br /> THIS PERMIT It ISSUED.I SII NOT EMPLOY PERSON m SUCH A MANNER AS TO BECOME SUBJECT TO MMMM'S COMPENSATION"WOOF CALIFORNIA.- CONTRACTOR'S HIRING OR <br /> SUB CONTRACTING SKiNA1U CERTIFIES THEE LLOWINO:T CERTIFY THAT IN THE PERORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO <br /> WOIKMAN'S COMPLNBATIO LAWS OF CAU D--iN[APPLICANT rUST CALL So HOLOW IN ADVANCE FOR ALL REEOL RED INSPECTIONS. COMPLETE DRAWING BELOW. < <br /> t11 ✓1II-- /tIy fI�I,,� J� �' 'R'r DATE! <br /> SIGHED A <br /> Y I r(1 Vyf'I �_ ��. L� . TITLE: <br /> • PLOT RAN MD W TO SCALE)SCALE---Ie <br /> `--i M. LOCATION OF HOUSE SEWAGE CUPOSAL SYSTEM OR PROPOSED <br /> 1. NAMES OF STREETS OftROADS NEAREST TO OR Wt)NDINO.THE RIDPFIRY1 EApMBION OF SEWAGE DISIVBAL SYSTEMS. <br /> 2. OUTLINE OF THE FPORRTY.WITH DIMENSIONS AND NORTH DIRECTION. S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFFY FT.ON <br /> 3. DIMENSIONED OUTLINED AND LOCATION OF ALL EXISTING AND PROMSED STRUCTURES, THE PROPERTY OR ADJOINING PROPERTY. <br /> .. . IMLUNNO COVERED MEAS SUCH AS PATIOS.DRIVEWAYS.AND WAUKS. _ <br /> �l <br /> ID <br /> W v 0 ov Eaa <br /> 1 <br /> ,r:T <br />