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APPL�CJ <br /> ,MTN FOR LIQUID WASTE PERMIT <br /> SAM-ANIN COUNTY PUBLIC HEALTH SERVIC' <br /> -INVIRONMENTAL HEALTH DIVISION I e4Q.T <br /> P.O.,BOX 383n5AST WEBER AVEME�STOCKTON, <br /> ss"'. (2013)486'442 <br /> I �, . <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUEDt(AUT <br /> (C-pt.t.in Tripkt.) <br /> APPLXAT10N 19 14EREBY 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 /> joAoulN COUNTY DEVELOPMENT TITLE.CHAPTER 9.1 110.3 AND THE STANDAF0OS OF SAN Jo^0UN COUNTY PUBLIC HEALTH SERVICES. MENTAL HEALTH DIVISION. <br /> ft. JOB ADDRESS/ORAPN, CITYLOT SIZE <br /> OWNER'S NAMEADDRESSA. SS <br /> CONTRACTOR_:Offir- —Lc,72;�R3 <br /> SUR CONTRACTOR DOPISS PHONE <br /> TYPE OF$471W WORK: NEW INSTALLATION(tv- AFFAIRIADDITION❑ DES-UC-m <br /> ❑ <br /> NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAl.WITHIN 200 FEET OF S—I PFRC TEST. <br /> l 1 HOW RANT' <br /> ApplI�d�S <br /> INSTALLATION WILL SERVE: RESIDENCE dr�COMMERCIAL 11 OTHER 0 <br /> NUMBER OF LIVING UNITS! I NUMBER OF 11FDROOMS:�.—MUAPtOYfW <br /> CHARACTER OF SOIL TO ADEPTH OF FEET: -�P4ZJ) PRI/SUMPSOIL CHWATER TABU DEPTH 70 <br /> &EP`DC TANKIORFASIE"" [I TYFVMFG P-, CAPACDY.�t- . NO-COMPARTMENT <br /> PILO TREATMENT PLANT 0 DISTANCE TO NEAREST: WELL 112 04 FOUNDATION "IDPERTY LINE <br /> LFT STATION O SIZE—TYPE OF PUMP- —SAND OIL SEPARATOR(ENCLOSED SYSTEM) - �3 <br /> 0 No.a LENGTH or LINES &-R DISTANCE TO NEAREST: /010 FOUNDATION <br /> FILTER BED [3 WIDTH_LENGTH_DEPTH --DIGIANCETONEAREST:WELL FOUNDATION- - PROPERTY UNE <br /> MOUNDED0 WIDTH—LENGTH DEPTH DISTANCE TO HEAWST:WELL FOUNDATION—PRJPERTY LNE— <br /> SEEPAGE RTS 0 DEPTH - --r-NUMBER —DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE 731— <br /> C3)0 T.ajO M--L-2—DEPTH 10 DISTANCE TO NEAREST:WELL FOUNDATION /// PROPERTY LINE <br /> DISPOSAL P.... El WIDTH LENGTH=—DEPTH DISTANCE TO NEAREST:WELL-FOUNDATION PROFERTY LINE— <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WW WRL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND,STATE LAWS,AND RULES <br /> Res AND FIEGVLAT NS Of THE SAN"^OkM COUNTY.HOW OWNER OR LICENSED AGENT'S SIGNATURE CERTIEW8 THE FOLLOWING:I CERTWYTHAT IN THE PEFIFORM"CE OF THE W014K FOR <br /> 6 ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUSACT To WoWMAN'S COMPENSATION LAWS OF CO V.) <br /> 'D CALIFORNIA-' CONTRACTOR'S HIRING OR <br /> THIS PERMIT 1 -7 CERTIFY THAT IN THE PERFORMANCE Of THE WOW FOR WHICH THIS PERMIT 99 ISSUED,I SHALL EMPLOY PERSONS SUS-FECT TO <br /> SVB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: <br /> THE WORKMAN'S COMPENSATION LAWS OAF.0 LORA-' APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED M"qCTIO".COMPLETE DRAWING BELOW. <br /> SIGNED X 7Z4 e <br /> T—: <br /> PLOT PLAN MAW TO SCALE)SCALE_'1. <br /> DING THE PROPERTY. S.LOCATION Or HOUSE SEWAGE 6'R"OR POSED <br /> E SYSTEMS.1.NAMES OF STREETS OR"DADS NEAREST TO OR BOUNDING <br /> 'I OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION Of SEWAGE INCLUDING COVERED AREAS SUCH A-PAT r"VE <br /> 7.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, LOCATION OF WELLS WITHIN KAIXUB OF ONE HONORED FIFTY FY- <br /> ON <br /> -'DO Wfea.A; -E DA�00HG PROPERTY.y. <br /> -'WAMS' <br /> 170 <br /> V, <br /> 2�. 6 <br /> SFr 7.! <br /> FOR DEPARTMENT USE ONLY <br /> ft. DATE: AREA:ACCEPTED By I FINAL INSPECTION BY DATE <br /> TAW,PIT on SUMP INSPECTION By DATE-- I <br /> ADDITIONAL COMMENTS: VQ <br /> J <br /> c <br /> �ACCOUNTING ONLY: AD' <br /> PE CODE FEE INFO AMOUNTRENSTTED vC... t- <br /> &A I T NLMSER INVOICE I <br /> Z <br /> -7U <br />