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A CATION FOR LIQUID WASTE PERMIT <br /> SAN'JWQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 446 N. SAN JOAQUIN ST., STOCKTON, CA 962010388 <br /> (209) 460-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICemplata in Triplicate) <br /> -Pl`ITION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOW DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> IAOUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 ANDTHESTANDARDS OF SAN JOAQUIN COUNTY RIBLIC HEALTH SERV/^CES,ENVIRONMENTAL HEALTH DIWSION. <br /> IB, -DRESSIORAP//N''I .�3[`�Ni �1\�J1["l 'vG'A CITY Y�At+'Kt% LOT SIZE I1i 1'�[17L} <br /> NN`S NAME L_1i51 C"�1e' I-[:': "`5 ADDRESS �_Y).�'C-J �.t..112'/yJ 'LZ�- RHONE <br /> )NTRACTOR !c>-AC_. C-�c iA: ADDRESS 17`'.\\ �7�Ls-Y•kr. \\��{�t.. UC! �'I RHONE <br /> IB <br /> R NTRACTOR S ADDRESS IJCM PHONE <br /> 'PE OF SEPRC WORK: NEW INSTALLATION ❑ REPNRIADDITON UL DESTRUCTION ❑ <br /> O F"TIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN ZOO FEET OF BUILDING.) PERF.TESTI.)I I SLOW MANY <br /> ApPllwtlon P <br /> STARATION WILL SERVE: RESIDENCE 21 COMMERCIAL 11OTHER 111MBER OF LIVING UNITS:/ 11 NUMBER OF BEDROOMS: _J NUMBER OF EMPLOYEE/: ^� <br /> HAI :TER OF SOIL TO A DEPTH OF 3 FEET: CIT!—r RTISUMP SOIL CHARACTER:�n4 �J:w,c� WATER TABLE DEPTH O <br /> PT—rANKIORFASE TRAP ❑TYPE/MFG CAPACITY NO.COMPARTMENTS 'V <br /> :O TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE p <br /> FT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) (V <br /> AC 10 LINE & NO.S LENGTH OF LINES / K. I'JJ ' DISTANCE TO NEAREST:WELL(_SN1 FOUNDATION �'?/ PROPERTY LINE <br /> e� <br /> .TER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE //�� <br /> JUNnm ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL-] <br /> ELL FOUNDATION PROPERTY UNE U• <br /> EP E RTS UDEPTH S ' SIZE tJ•• NUMBER DISTANCE TO NEAREST:WELL -J�FOUNDATION �bUt PROPERTY UNE //IV' C' <br /> mm ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE � <br /> SMSAL PONDS ❑WIDTN LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> HER f CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES T <br /> .D REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THEWORK MAWHICH <br /> IIS PERMIT IS ISSUED,I SHALL HOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR A <br /> �6LONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> JR AN'S COMPENSATION/lAW0 OF CAUM IA.'%T///FJ�E APPLICANT MUST CALL 34 HOUIB IN ADVANCE FOO ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELLOW. <br /> ;NEDX �J_l /ii.1� /,((,'/// `�'/ TITLE: GK'S✓1C/� DATE: %`c,�Cl ltS <br /> PLOT RAN(DRAW TO SCALE)SCALE 'to <br /> N. ES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> ONLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> DIMENSIONED OUTLINES AND LOCATION OF PLL EXISTING AND PROMSED STRUCTURES, S. LOCATION OF WELLS WITHIN MOUS OF ONE HUNDRED FIFTY FT.ON <br /> INr''/DING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WAMS. THE PROPERTY OR ADJOINING PROPERTY. <br /> V G_ <br /> �L. �„ , <br /> II Ur�w <br /> 1 NN'tt Z S Eli`•"` <br />