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APPLICATION KIR LIQUID WASTE PERMIT" —J -4a <br /> "" � <br /> U74 JOAHIN CCURY PUBIIC HEALTH SEBV19EFAID <br /> ENVIRONMENTAL HEALTH UIVISION # 1 <br /> P.Q.M SNB,'fAB N.SAN JDAIMIN ST.,STOC1iTON,OALL <br /> (209)466'3-020 f <br /> NOl7 <br /> 01,05fD SJIT tKPIR 11M s NV# <br /> FAmobta Lo TripL4atal <br /> APPIIcotlrn la hereby r.�ado to thea San Joaquin Crlunty (or b po-it to conotruat and/o. im toll the 24orkdagCUZ�j <br /> 1a made In c&�ppl lance wi th Eon Joegtrin Cotalty Devolopa:,nt I Itis, Chaptor 9-1110.9 al d the Stondarda of Son Joaq In Cotarty Ptbl is Health <br /> Service 0, ErM r6vital Health Olvhd w, <br /> Job Address/or APHaf 1�0 1/1� S t ✓<w 1 Clty �Lot size <br /> 09rra r'a HaT6 Xr='1.n vs.IL �-P V �ddreaa d• Yt u ph onr. -/�7 j�� <br /> Contractor V 1 9Jl Ac'droge _ LIc3 Phone <br /> Sib Contractor AtkJrese Liep+ Phona <br /> TTPE OF SEPTIC WDRH: HEW I119TALIATION 04-- 01PAINADOITION I I UMNOTIOW i I PE RD TEgfD)(11 Hari—r— <br /> (40 <br /> r(40 SEPTIC SYSHII PEPHITIED (r P1.1000 FEWER IS AVAILABLE VITHIM 2617 my of GUILDING.) <br /> loco Ura AppIk.11oa 0 <br /> Ingtallatloa will sarvol Rig]denso® Comn2rclal Other <br /> wuetbar of IlvinD LnItor_ uurbor of bedr—i H'Inbar of mgtoygeaa (� ��yy� <br /> Character of toll to a depth of 7 f0att G t-I U w--u IuSurp Soil Character,. /AiWatrr table Depth <br /> IIPTIRTAMOAEAUTRAP IT VIN Capacity— c51d0�g4/Ho. Co'"rtwnta <br /> PHO TREATUEMT PLANT PJA blstencc to noorsst: Uall iouvletlp r`/ Property llno- <br /> LIFT STATION] She,_,T,Typo of Pcup SoM DIl geparator (enmloto4 ■yotvm) <br /> LEACHIMO LINE Cl No. A length of llnas 3 - >C)a) 7 Olatoneo to Htoroctc Wol(�0 Q �FounifatIor.20 0 Property Lfry��S" <br /> FILTER 00 C1 Width Length_____Dopth_.._. ° ^ well Foontiatlon-_Property Lina /r <br /> klallHDEo [I Width Length Depth " Well Foundation Proporty LIne t <br /> SEEPAGE PIT8 fl Depth_ Size Wunber " " Wall Fo"atlort__Property Line -{- <br /> CUMPG i1 Width Largth 0epihs_ " " Wall_ Iw4Wat[on Property Line <br /> OUPOSAlPDMOs 11 width Length Depth ° s Ust1 Foundatlan Property Llre <br /> I hiretry certify that 1 have prepared thio app(fcotlon end that the work will be done in accerdanct wl kh San Jaequln CCA ty Ordln.ncee <br /> and Stott Laws, ani Rules and Rogulatlona of the San Joequln County. Horne owner or lleeev ed ogent'a algnaturo ccrllfics the following <br /> I "i certify that In the performance of the work for which thio permit to IsBued, 1 shall not winioy any person In such o m rwvr as <br /> to becaoe sL6)—t to workman`s ro penrotion lows of Celifornla." Contractor's hiring or aub•contract Ing signature oertlflea thaw <br /> fotIbVingr "I certify that In the performmo of the work for which this permit le Issued, I shell ccploy parscna itibloct to workman's <br /> cniponse r 1 Call(ornle." <br /> Thr oppUhAl mait-!024 hours Is a va r aJl raqulrsd rptallass. Conplete drawing below. <br /> Signed X Title: /Data: <br /> PLOT PLAN (Draw to$tela) Scale_�r' to <br /> 1, Parma of atreete or roods nearest to or Mc-Ilnp the property. 4. Location of howo sewage d(epgoat gyatm or <br /> 2. Oatllne of the property, with dfnenylona and Horth dire-fl-n. propoce4 axpanelon of towage dispoeat oyatoma. <br /> 3. Dltwnslonsd outlirwo and location of all axltting and propotsd 5. Lecatlon of wall$ within radius of 150 ft. on <br /> xtructuran, Including covered orsop cu h as potion, drlvoways, the property or edJo(nln0 property, <br /> and walks. <br /> A- cw er- <br /> / 7 ' <br /> PAYMEK <br /> # R I e0 E IV K.D <br /> AUP ji 1934 <br /> 'T <br /> P T�1L ZEAL {i Df'ISTD f <br /> t <br /> 71e � -Kr$fi-t81A- FOR DEPAM IENTUSEDWIY 7 <br /> Appllcation Accepted by ,� <br /> Tent, Plr or Swap lnepeetlen by bolo / ,,,(_ Final Inspection by <br /> Additional Cw mcntoc <br /> AMIJUTI1(D1111Lyr Atoll FALB `tilt, cvH,,tc{t.�- wOlx6t . <br /> PE CODE FEE lNfo MOUNT RELUTTID CHEC CASH I DECEIVEO @y DATE on 1 PEA$Hr lTuma. IRVOICE€ <br /> ( r ( 44J I <br /> 37 <br />