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APPLICATION FOR LIQUID WASTE PERMIT O O <br /> NW► SAN JOAQUIN COUNTY PUBLIC HEALThmoeRVICES W t65Q <br /> ENVIRONMENTAL HEALTH DIVISION U �`7 l <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> _ ABN-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> IC*.plttt lI TrgGott) <br /> APPLICATION IS IEMBY MADE TO THE SAN JOAOUN COUNTY FOR A PERMIT TO CONSTRUCT ANDtOR INSTALL THE YAR(DE--BED.THIS A'PIJCATION IS MAOE N!COMPLIANCE MATH SAN <br /> JOAOVM COUNTY DEWLOPMENTTITILE,CHAPTER <br /> (9-1110.3 AND THE"ANDAImt OF SAN 1J DAAq�A.µ)y�GpVNTY PUSIJC HEALTH SERNC ESS.�EHVC10NMFNTAL HEALTH"IN <br /> NON. <br /> ISL/1 '` CRY tloT"`�� LOT <br /> JOB ADDIIESWOR AT'Nf -2 <br /> - OWNER'B NAME •✓ <br /> - ' AODIES6 NIC/ PHONE <br /> — <br /> 0 <br /> CONTIIACTOR 02 1rw <br /> BVB CONTRACTOR <br /> TYPE OF SEPTIC WORK MEW NBTALLATION yF / REPAOVADDITIOM ❑ DFf TADCTON❑ <br /> NO SEPTIC SYSTEM PEHSMTI EO IF PUBLIC SEWER IS AV BLE MATMN TOO FEET OF BURDINLT.I PEtC TESTI�11 1 NDW MMT <br /> f/,/JH APPtsian S <br /> INSTALLATION WILL COMMERCIAL❑_ OTHER❑ <br /> NUMBER OF HYIMG UMTS: _ NU SI9 OF BEDRO MSNUMBER OF EMPLOYEES: I <br /> CHARACTER OF SOX TO A DEPTH OF 3 FETr e&4j PR/SUMP SOX C14ARACTEM��%�i� KI IYI WATER TABLE <br /> 11EPTN -f- <br /> SEPTIC TANE/6 f TR" ElTYF4/mm r �CAPACRY "_y NO.COMPNi1TAET(i6��j�� <br /> PRO A <br /> TREATMENT RNT 11 "STANCE TO NEAREST: WELL ^ FOUNDATION l PROPERTY LNtE...1_— <br /> UFT STATION❑`SRE TYPE 0,7p SAND OX SEPARATOR IUNCLOSED SYSTEMI / <br /> USACNNO UNE 4 NO.i__OF L1NF8 �_ /�-� "STANCE TO NEAREST:WEiE�FOUNDATION�' PROPERTY NINE <br /> FILTER SED /❑WIDTH IENGTH DEPTH "!RANGE TO NEAREST:VMI FOUNDATION PROPERTY LME <br /> MOUNDED ❑VDDRI T IENGTH /• ' DEPTH <br /> } DISTANCE TO NEAREST:WELL {J FOUNDATION PROPERTY UNE <br /> A DEPTH d j �NUMBER "STRANGE TO NFN EBT:WEED"x FOUNDATION=PROPERTY L1NE� <br /> t®AGE RTi SQE <br /> SUM" ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOI/NDATION P1IDRRTY LANE <br /> "tPDBAI POND! ❑WIOTN LENGTH DEPTH "STANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> 1 HEIS,CEKTIFY THAT 1 MAW pNE AXD I—APRICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WRN SAN"AMIN COUNTY ORDINANCES AID STATE LAWS,AND AURES <br /> AFD/EGVIATIONt OF THE SAN JOAOVIN COUNTY.HOME OWNLT OR INCENSED AOEM'i SIONATUIE CERTIFIES THE FOLLOWINO:MCERTFYTHATMTHE PEMOMIANC�11ACTOR'f PNIMD On <br /> THIS PEIMA/T q 1881/ED,I SMALL NOT E1Ari0Y ANY PERSON IN SUCH A MANNFIR TO BECO*IMMACT TO WOHCMAN't COMPENSATION LAri't OF CAtIIONMRA_' <br /> St)6COMRACTING SIGNATURE CEKTN-W$THE FOLLOWING:l THAT M T PERFORMANCE OF THE WOW FOR WHICH THIS PEN"ST q ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO <br /> AN tT CALL IN ADVANCE FOR ALL REOLrff"pNSP MMS.COMPLETE DRAWING BELOW. <br /> NEAT UWCB O/F�GAIFORgA'TLIE �jjj��l�JJJ <br /> TALE: DATE: �S 1 <br /> BIOFED X <br /> ROT PLAN(DRAW TO SCALEI SCALE_ <br /> 4- <br /> LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR ROPOSED <br /> IME <br /> .NAS OF STREETS OR ROADS MEANEST TO OR BOUNDINO THE PRORATY. EXPANSION OF SEWAGE DISPOSAL loo' S. <br /> ,OUTLINE OF THE PROPERTY,WITH DIAEHBIONB AND NORTH DIRECTION. B.LOCATION OF WELLIU <br /> S VRTMN RADS OF ONE HUNDRED FIFTY FT.ON <br /> M <br /> ]-DEBIO <br /> NNED OURPEB AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, THE PROPERTY OA ADJOLNING P}1OPE11f'/ <br /> S,, VERm AREAS SUCH AS PATIOS,gMVEWAY8,AND WALKS- <br /> �Ip <br /> 122. <br /> cl <br /> �t <br /> c rA�'M ENI <br /> _tkeaL MAR 215 1999 <br /> 11 _. aLteuc HEAtTH++sfmrir r. <br /> PL <br /> FON DEPMTMENT UBE ONLY <br /> _ DATE: <br /> APPLICATION ACCEPTED BY <br /> DATE I I FINAL WSPECTION BY DATE ✓ /��f <br /> TAMC,PIT OR BUMP MSTSC710y1,1�S�1Y <br /> ADDIMNAL COMMENT S: IV l/ `ILTYI� Q �I <br /> f 3 <br /> ACCOUNTING ONLY: NDS FACS <br /> _ PE CODE FEE INTO AMOUMT RUM ITEO CHEC ASH RECFiVED BY DATE YT/P9MT HUMBER INVOICE S <br /> Pub.HealM So"--Ermiro.174(3/96) <br />