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APPLICATION FOR LIQUIO WASTE PERMIT <br /> SAN'JOAOUIN COUNTY PUBLIC HEALTH 8ERYICE2 <br /> ENVIRONMENTAL HEALTH DIYISION <br /> P.O.BOX 998,304 EAST VVVEIER AVENUE,STOCKTON,CA x6201388 <br /> (2021 461.3420 <br /> NOWAUUNDAELE PEBNDT EXPIRE!1 YEAR FROM DATE InVED <br /> TAmpleb In Tr1pls.MMI <br /> APPLICATION W FWPM FY MADE TO THE MAN JOAGMN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DEOCAMIED. TIM APPLICATION 18 MADE N COLOVANCE WITH MAN <br /> JOAOUN COUNTY DEVELOPMENT TITLE,CHAPTER 5-1110.3 ANO TIE RANDARDD-S OFIMSAH JOAAO'U^N UN <br /> COTY RMLK: RV <br /> HEALTH SERVICES.ENVV4NUEKTAL HEALTH OM**N- <br /> ,rJOSAOORESMAAPNN 0--3-- I`J�5 / ��Lr 1"r ,op, <br /> D r 77���� _Knr <br /> S MaE p <br /> OWNEJI• NAA40 �- AOG CH ADOREBe -ZSP <br /> `4y u Tc H bR / <br /> 4y t. <br /> coNiRAcroR TIa C lG F/I4S77A'jC� ADOREMI � �x /7p/�`aT iX ,X10 - b7-i.tS'&]. <br /> MIM CONTRACTOR AOU/IEIM <br /> TTP(OF Manx WORK: -vow BRTALLATON❑ R&PAdVADDIT10N ❑ DSSTRVCrIOI❑ ' <br /> NO SEPTIC SYREM PERMITTED F"JC MINER N AVAILABLE WTION 200 FT4T Gf WROOM.I PEI:?=lwI <br /> •AM r-r fes. AroM�Maw <br /> INSTALLATION WDLL SFJNE REIIDENCE+MLR COMMERCIAL TJ OT"FR❑ rG LMII w t1T7A" <br /> NUMMI OF WINO UNTB:_L—N&ABEI OF BEDROOMS: �� WAMM OF WAFLOYTMM: <br /> CHARACTER OF MOIL TO A DEPTH OF 3 FEET: TTTSURAP SOIL CHNIACTF1l WATER TABLE DEPTH <br /> SSPTIC TANK/OIFAMO TRAP ❑TVPCMFO CAPACITY NO.COMVARTMENT9 <br /> __J3NT1' <br /> MIO TREATMENT RANT 173IS <br /> DISTANCE TO IEARNSY: IVELL FOUNDATION gOp(RTY LIRE PJB G^,EA TH SER VICES <br /> UFT(TATICK❑ Min TYNE OF{'LIMP SAND OR BEPAMTOII rtNCLAIm BYETEMFI 'Imm "IINTA.!HFA--lm EVF•^;J <br /> K./ACRMNO UNE ❑ NO.■LENGTH OF UNE/_ DISTANCE TO NEAREST:WILL FOUNDATION FROPER/Y LIN[ <br /> HLTM BMD ❑VADTH LENOTHTy-DEPTH OIFTANCE TO IEARIM!WEEL ,FOUNDATION P'RJFENTY LINE <br /> MOUNIM ❑vom tFIDTN _OEPTN DISTANCE TO NEAREST:WELL —FOLODAT/ON PNOFERIY EINE <br /> MVAEE HTS ❑DEPIH 012E NUMBER MBER DKfTANCE TO NEJVE&T:WELL FOUNDATION P/pF7TY LINE <br /> gBAPM FLJTL WOTH LENGTH DEPS E (TL <br /> DWTANCF TO NFA TT:VY __FOUNDATION PROPERTY L <br /> R--J ORD"1006"DP06"PONS L. VADTN LINOTN rAMR DISTANCE TO NEARERV4! <br /> LL--WL FOUNDATION PROPERTY LINE <br /> I HFRI7Y CI RTFY THAT 1 HAVE PREPARED TWO APRICATION AND THAT TT/I W01R WILL K DONE N ACCORDANCE VJTN MAN JOAGURN COUNTY ONONA HCFS ARD STATE LAWS,AND MULE( <br /> AO PEOUlAT10NO OF THE IAN JOAQUIN COUNTY.HOME OWNHL OR LICENSED AGENT'S&IGNATURE CEHTFES THE FOLLOWING:'I CERTIFY T THAT IN THE PVM ONAAHCI Of THE WORK FOR WHICH <br /> TNM RIEAT IM ISSUED.I&HALL NOT EMPLOY ANY PENBON IN(UCH A MANNER AM TO BECOME SIUIWfCT TO WW MAWB COMPENSAT0F1 LAWN OF CALL WOMOA.• COW PACTOICS/OFEIq OR <br /> SUB-CONTVLCTING SIONATUIF CEPTFES THE FOLLOVVIIO:•1 CETTFY THAT N THE PEMOMAANCE OF THE WOFA FOR WHICH THIS PERMT IB MMUFO,1 SHALL FMR.OY PERSONS MM.IECT TO <br /> WORKMAN'&COMPFNSATI VVI OF CA IA: TIE APPLICANT MINT CAEL H 401,4409NOIN ADVANCE FOA ALL FAOLMRIV INSMCTIONS. COMPLETE DRAWINO NIE OW. <br /> i � <br /> BIGNEO X TT-E: <br /> DATE. DLJ'0�' <br /> ROT PLAN(DRAW TO OCALE1 McAL( <br /> 1.NAAES!k STREETI OR ROADS NEAREST TO OR 00UNDM THE PROPERTY. RNC LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR POWMEE0 <br /> 3.OUTLINE OF THE PROPERTY,VYrrK DIMEN ONS AND NORTH DIRECTION, EXPANSION OF SEWAGE DISPO&N.&YSTEMM. <br /> 3.OOAENSONED OUTLINES AND LOCATION OF ALL(ARAM AND ROPOOW MTMICTUREM. B.LOCATION OF WELL&WTRl1 RIADMM Of ONE N OMPED PIETY FT.ON <br /> INCLUDING COVERED AREAS MUCH AM PATIOS.DRIVEWAYS,AND WAUKI. THE PMPCMY OR ADJOINING PROPERTY. <br /> ... . <br /> ! ' i �• _ --- - —I- Via- -' I 1 r - - - - I i <br /> .�..� � SK its•.4 -�-- -.—�- , '- - i\�I. j_.r���_! _�..� ;._ .. •,•"f• <br /> -fj- <br /> ,- <br /> I <br /> L. _ <br /> . . .. <br /> ire <br /> 1. _ . . . ... � <br /> 0. <br /> I .. <br /> ..... ............` - < .r A- <br /> -- - EIR DIFARTME T IME OIILY ... <br /> APRICATON ACCEPTFO SY DATE: d�.& <br /> TAM(.T OR MUMP INSPECT N SV DATE FINAL INSPECTION MY DATE_ <br /> AODTgNAt COMMENT S: <br /> qj <br /> ACCOUNTING ONLY: <br /> r'CODE FEE INFO AMOUNT REIMT7EDCiR[CK/ ASM F.C.BY DA7F )►fINT WVOIC(f •'�� <br /> d <br />