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APPLICATION FOR LIQUID WASTE PER& _ <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 445 N. SAN JOAQUIN ST., STOCKTON, CA 95201.0388 <br /> (209) 468-3420 <br /> NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Application is hereby made to the San Joaquin County for a permit to construct and/or install the work described. This applicatioi <br /> is made in compliance with San Joaquin County Development Title, Chapter 9-1110.3 and the Standards of San Joaquin County Public Healtl <br /> Services, Environmental Health Division. <br /> Job Address/or APN#�$ j` /� He L-L� ��. City CA/ Lot Size <br /> Owner's Named ro�clay 5 r'L v A Address_ -5 +4,4 Phone S'y s ciC <br /> Contractor Aiy//SrrivY -6 SON AddressbeV2 (iGl'Fgti�9 /}ut ��.��L�PIr7 Lic# V "y(-5-71 Phone <br /> Sub Contractor Address Lic# Phone <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIRIADDITION DESTRUCTION I I PERC TESTIS)(J How many <br /> (NO SEPTIC SYSTEM PERMITTED IF,PUBLIC SEWER IS AVAILABLE WITHINXO FEET OF BUILDING.) <br /> Land Use Application / <br /> Installation will serve: Residence Commercial Other"of>iL tl6e4✓ <br /> Number of living units:_ Number of bedrooms: 3 Number of employees: <br /> Character of soil to a depth of 3 feet: /-I&A`/,> Pit/Sump Solt Character: 5A.n V .47 6' Water Table Depth <br /> SEPTIC TANKIOREASE TRAP " Type/Mfg /�,° G4S7 Capacity /;-tea No. Compartments L <br /> PKG TREATMENT PLANT ( I Distance to nearest: Well Foundation 3;- Property tine .4(1' <br /> LIFT STATION❑ Size Type of Pump Sand Oil Separator (enclosed system) <br /> LEACHING LINE )I No. 3 length of lines3- 4119 Distance to Nearest: Well �'6' Foundation ;2�' Property Line � <br /> FILTER BED () Width Length Depth it Well Foundation Property Line <br /> MOUNDED () Width Length Depth " " Well Foundation Property Line <br /> SEEPAGE PITS U Depth Size Number Well. Foundation Property Line <br /> SUMPS X Width �' Length /11' Depth /S' Well Foundation Property Line <br /> DISPOSAL PONDS (I Width Length Depth " " Well Foundation Property Line <br /> I hereby certify that I have prepared this application and that the work will bo done in accordance with San Joaquin County Ordinances <br /> and State Laws, and Rules and Regulations of the San Joaquin County. Home owner or licensed agent's signature certifies the followini <br /> : "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such a manner a: <br /> to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies thn <br /> following: "I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's <br /> compensation laws of California." <br /> The applicant must call 24 hours In advance for all required Inspections. Complete drawing below. v,et C <br /> Signed Xi - -U'Cd Title: Date: <br /> PLOT PLAN (Draw to Scale) Scale " to <br /> 1. Names of streets or roads nearest to or bounding the property. 4. Location of house sewage disposal system or <br /> 2. Outline of.the property, with dimensions and North direction. proposed expansion of sewage disposal systems, <br /> 3. Dimensioned outlines a location of all existing and pro ed 5. Location of wells within radius of 150 ft, or <br /> structures, including c eyed areas such as patios, driv aye, the property or adjoining property. <br /> and walks. j+'laai 4 t-/GY"lr° <br /> 17 <br /> C <br /> z <br /> z 'r <br />