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p APPLICATION FOR LIQUID WASTE PERMIT <br /> JOAQUIN COUNTY PUBLIC HEALTH SE VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> NOW-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (Complete In Triplicate) <br /> APPLICATION 10 HERESY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRBED. THIS APPLICATION IS MADE IN COMPLIANCE WRM BAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9--1110.30 <br /> -1 1 10./3�AND THE STANDARDS OF <br /> SAN JOAQUIN COUNTY PUBLIC HEALTJH SERVTCEB.ENVIRONMENTAL HEALTH DIVISION. <br /> JOBADDRESSlORAPNI v1' �� `� "� 1f„ 00r-c y�W � CITY • <br /> LOT SIZE <br /> LADORES PHONE64IoM <br /> OWNER•8 NAME o�Lxyy nW <br /> ,,++ ,1� /��_A C/ +�� _ <br /> CONTRACTORiy� hV71. �� ADDRESSa� nN3LJS'I�� L.H7l� j �`I / PHOW367-0 _ <br /> SUB CONTRACTOR ADDRESS LIC■ RHONE <br /> l TYPE OF SEPTIC WORK: NEW N&TALLATION ❑ REPANUADDIVON ❑ DESTRUCTION ❑ <br /> VINO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) FERC TFJIT[s1 1 (HOW MANY ^ <br /> APdTort&on F <br /> INSTALLATION WILL BEIVE: RESIDENCE❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOM&: NUMOM OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> SEMC TANK/OREA&E TRAP L7 TYPEMIFO CAPACFTY NO.COMPARTMENTS <br /> PKO TREATMENT PLANT❑ INSTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> LIFT STATION❑ SUE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM) <br /> k LEACH INO LINE ❑ NO,k LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> FILTER BED ©WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> Il MOUNDED ❑-1 w.TH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATKIN PROPERTY UNE <br /> SEEPAGE RY$ D EIEPTH SIZE NUMBER DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LIN£ <br /> SUMPS ❑YADT% LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY IJHE <br /> I' DISPOSAL PONDS [3 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> 1 HEREBY CERTIFY THAT I HAVE PFIEPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RUB <br /> AND REGULATIONS GF THE SAH JOAQUIN COUNTY.HOME OWNER OR LICENSED AOENT'8 SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT IN THE PERFORMANCE OF THEWORK FORYAIICH <br /> THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AB TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'&HIRINO OR <br /> SUB-CONTRACTING otGNATURE CERTIFIES THE FOLLOWING:-1 CEKFIPY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB ISSUED,1 SHAD.EMPLOY PERSONS SUBJECT TO ( - <br /> WORKMAN'S COMPENSATION LAWS OF CALJFORNNA.' THE APPICANT MUST CALL 2e HOURS IN ADVANCE FOR ALL REGUIRED INrS/P]ECTIONS. CO <br /> M <br /> PLETE DRAWING,+BELOW' <br /> STONED X TITh:: 'fit V' � �„y���� DATE: <br /> V <br /> PLOT PAN(DRAW TO SCALE)SCALE_ 'to <br /> e <br /> 1. NAMES OF STREETS OR ROADS NEARE6T TO OR BOUNDING THE PROPERTY. . LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> .cam <br /> 2, OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION THE PRO BER LS DISPOSAL SS OF ONE HUNbRED FIFTY FT.ON <br /> SYSTEMS. <br /> 3. DIMENSIONED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6, LOCATION F WELLS- WITHIN RADJOINING ROPERTY- <br /> OF O <br /> INCLUDING COVERED AREAS SUCH AS PATIOS DRIVEWAYS AND WALKS -- - <br /> . <br /> : <br /> . <br /> o <br /> Q <br /> I s... <br /> W <br /> . <br /> :. . .. ... <br /> O <br /> W13 <br /> t --;� : a <br /> - SAra'.,... <br />