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APPLICATION FOR 1.10010 WASTE PERMIT <br /> SAN JOAOUIN COUNTS!PUBLIC HEALTH SERVICES <br /> ' ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3820 <br /> NOM•REFUNOABLE PERMIT EXPIRES 1 YEAR FROM DATEISSUEO <br /> ' ARAION le HERBY MADE TO THE BN OAOUIN COUNTY WR --IT TO C0 <br /> 'pN8T RLUCRAT iAnNDIORINSTALL <br /> ALL THE WORK OE6CPoSE0.THIS APPLICATION IB MADE IN COMPLIANCE WITH BAN <br /> JOAOUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AMU THE STANDARDS OF1AN JOAO"UIgN COUNTY PUAUC HEALTH 8ERVICE3,ENNVVI'RO'NMENTAL HEALTH DIVISION. '�p <br /> JOB AVDRE68/OR/A/R�-YY/_�-IT,1v f C.i�J-6 S!F{�C� - e— 4/'JY I CRY Z_0' 6 L�OT�B]RE <br /> CWNER'S NAME l pll'g 1C 1-e-' F��(�K ADORES O,5 <br /> " Com" <br /> CONTACTOR �/"LCTT�IYL JCADDRESSf�� C. L�Gf/LLli•�/ t�I�• UCF NIONE T� <br /> ' SUBCONTRACTOR ADDRESS UCP PHONE <br /> TYPE OF SEPTIC WORK. NEW INSTALLATION REPAOVA001T10N❑ DESTRUCTION❑ <br /> ING SEFRC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUIL ING.1 PERC TESTd1 I 1 HOW MANY <br /> ``\\,_,/I AppSnUan A <br /> INSTALLATION WILL SERVE RESIOENCE9 COMMERCIAL D OTHER❑ <br /> NUMBER OF LIVING UMTS:_NU IS;OF 37 OMA: 3 NUMBER OF EMPLOYEES: <br /> �R OF 60140 A DEPTH OF J �ISUM�P SOIL HARACTER: ER TASLE DEPTH 7� ' ✓ <br /> [►LIC T KlOREAE[TRAP �TYPEIMFG �SSW CAPACITY d NO.COMPARTMENTS aC <br /> ' TMENT RANT Ll DISTANCE TO NLMUT: WE z44n L FOUNDATIONN� PROPERTY UNE <br /> UFT OVATION 0 SIZE TYPE OF PUMP SAND OIL SEPARATOR VXLOrEO SY@TEMI <br /> LSRCMNO UNE .NO.!LENGTH OF 9RNE6 <br /> —Yo, �'`��. DISTANCE TO NEAREST:WELLI�3o FOUNOATKIN le!) , PROPERTY UNE S� ' <br /> ALT®1 EE9 CI WIDTH LENGTH. DEPTH DISTANCE TO NEAREST:NIELL FOUNDAMII PROPERTY LINE <br /> MOUNDED +�❑.T�WIOTN LENGTH- DEPTH DISTANCE TO NEAFE:ST:wM FOUNDATION PROPERTY LINE®T <br /> SEEPAGE PIT3 l�VOEPIH 2;' eSZE �(o.. NUMBER _3DISrANce TO NEAREST.AYC 0160' FCUNDATTON P� � PI?JPERTY UNE ��bO <br /> SUMPS 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> GISPOAM FONDS 17 wDvN LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE l I� <br /> ' B HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL OI <br /> BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY OFNANCES AND STATE LAWS.AND RULES <br /> U <br /> AND REGULATIONS OF THE SAN JOAGNCOUNTY.HOME OWN ORUCEN$ED AGENT•@SIGNATURE CERTIFIES THE FOLLOWING-'ICERTWYTHAT IN THE PERFORMANCE OF THE WORK FORWHICH <br /> THIS PEIV.IR &INO A MANNER A@ TO BECOME SVBJECTTO WORKMAN'@COMPENSATION LAWS OFCAUPORMA.'CONTRACTOR'SHIRINSOR <br /> UILD FY THAT INTHE PERFOFMANCE OF THE WOR(FOR WHICH TMS PERMR IS ISSUED,R SHALL EMFLOY PERSONS SUBJECT TO <br /> WWRC AN'S COMMUST CALL 241/0LAL6 IN ADVANCE FORALLL IMUMED LHSFECTIORO.COMPLETE DRAWING BELOW. <br /> SlON X DATE:(DRAW TO SCALE)SCALE.-ro <br /> I,NAMES OF STREETS OR ROADS H EST TO OR SOUNDING THE PROPERTY. 4.IDCATgN OR HOUSE SEWAGE SI6POBAL SYSTEM OR PROPOSED <br /> 2. RIN <br /> OUE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OP SEWAGE DISPOSAL SYSTEALB, <br /> 3.DIMENSIONED OUTLINES ANO LOCATION OF ALL EXISTING AND IMPOSED STRUCTURES, Q 1.LOCATION OF� E HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS DRIVEWAYS.AND WM B, <br /> .. :.. ....:... .... ,. ..... ....a.. Q` <br /> _ ......... <br /> v. <br /> a.:....a.... .�......a.. .:.. <br /> i <br /> THE pigPTRIY OR ADJOINING <br /> a...... <br /> :......,.... .....e......:...._..... uok _ <br /> � v <br /> .... <br /> ....... <br /> A"N164T <br /> ....... <br /> �......: Ism <br /> ... s N <br /> ........., <br /> 1 <br /> a ._......a. :....�....;. <br /> ....... .' <br /> ................ ...�.._.. ..i.. <br /> is <br /> _. .... <br /> A <br /> PUEIL! SE7iVICE3 <br /> . ........ .EPIV.IRONMEM'fALH tU.1510N <br /> ..... ..i.....o....... <br /> e <br /> It'r.... .$............ ......:... <br /> ....` <br /> .:.'............: .. ........ <br /> '....a...._ <br /> ......... .............._..i.... <br /> ...... H$It �• ['i J r2A-1 <br /> ...,......€.....;... <br /> _.. �QO To .LJJ e., c, ._. ....?... <br /> .......i <br /> ....................:.......'._....a......:.......;......_..._i......:......!..... RDEPMTMENT WSONLY - <br /> F-0 <br /> 3 h <br /> APPLICATION ACCEPTED BY DATE: G AREA: <br /> T ,�OR BUMPIH6PECYiOPd SY DAT / fINAL INSPcCT10N Y ATD <br /> ' ADDITIONAL COMMENTS: --- <br /> ACCOUNTING OTRV: A1D(3 FACS <br /> PECODE I Fw INFO AMOUNTRIMNTED AEC MASH RECEIVED BY DATE SR IFSPp/T NUMBER INVOICES <br /> I <br /> ' Pub.Health SETV.-EnAro.174(3/86) <br />