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APPLICATION FOR UOUID WASTE PERMIT <br /> S..JOAOUIN COUNTY PUBLIC HEALTH SERVICES A <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 952021�� <br /> (209) 468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED \,r, <br /> (Camplan In Triplicata) <br /> A ICATON 16 HEREBY MADE TO THE BAN JOAGLBN COUNTY FOR A PERMIT TO CONSTRUCT ANOMR INSTALL THE VAR(DESCRIBED. THIS APPLICATION IB MADE IN COMMANCE VATH SAN <br /> JOAQUIN COUNTY OEVELOMENT TFTLE. �1/CHAPTER�9-/11110.3 AHO <br /> THE 1ANDARRQG OF SAN JOAQUIN COUNTY WBUC HEALTH SERVICES.ENVIRONMENTAL HEALTH OIVBqIN. <br /> JOB ADDRESBAR APNF I OH / ,6 a. l n u(r1T ✓ARrov 'e— Ra CITY ��+ t0,� �) LOT SIZE /I "C- <br /> OYMEfl'S NAME I��n cA- M CIh e c RE <br /> ADDSS P O,Lnx� ) <br /> / I 7 0/I i -rC' 2 A7 PHONE e Z-! ,Z-1331 <br /> CONTRACTOR D Lv /) er ADDRESS LIC! (06 0 PHONE <br /> SUB CONTRACTOR ADDRESS UCl PHONE <br /> TYPE OF SEPNC WORE: NEW INSTALLATION EPP REPAIMADDITION ❑ DESTRUCTION ❑ <br /> (NO SEPTIC SYSTEM]REMITTED IF R BUC SEWER IS AVAILABLE WDHIN ZOO FEET OF BURDINO.1 POIC TEXTI.1 I 1 NOW MANY <br /> Apptlatlen / <br /> INSTALLATION WILL SERVE. REsiotmE 0 COMMERCIAL ❑ OTHER 13I <br /> NUMBER OF LIVING LRBTI:� NUMBER OF BEDROOMS:_ Numem OF BAPLOYEES: O <br /> CHARACTER OF 601.TO A DEPTH OF 3 FEET: MASUMP SOIL CHARACTER: CL <br /> W/A�TER TABLE DEPTH h <br /> SEPTIC TANIOGREASE TRA'''---P111 O TYPE M O on 4a 4-7"— CAPACITY � -/_O � CL 4 L— NO.COMPARTMENTS <br /> MO TREATMENT FFTDISTANCE TO NEAREAT: WELL FOUNDATION F ROPERTY LINE �! <br /> LET STATION"E TYRE OF RIMP A SMDOILSEPARATOR(ENCLOSED SYSTEMI f� .{.. <br /> LFACHNG ONE NO F LINES I[ONO 1 DISTANCE TO NEAREST:WELL SO F'I-NIDATEIN /w � PROPERTY IMF- �T / V <br /> FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> MOUNDED ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION FNOPERTY UNE <br /> SEEPAGE PTS 0 DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL OPE <br /> FOUNDATION PRRTY MESUMPS 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PIOPERIY ME E\ <br /> DISPOSAL PONDS 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE- <br /> --I HEREBY CERTIFY THAT 1 HAVE RIEPARED THIS APPLE:ATION AND THAT THE WORK WILL SE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER ORMENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:"1 CERTIFYTHAT M THE PERFORMANCE OF THE WOR(FOR WHICH <br /> THIS PERMIT IS ISSUED.1 SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CIRIFORNIA." CONTRACTOR'S AIRING OR <br /> ` SUB CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:"I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO ` - <br /> NOEKMAN'S CQ[APENSIAWR'OF CAL1fO1W1A.' TH(APPLICAN�ALL 3S IbUU IN ADVANCEFOR�RFOUR�IiSR✓;NS. COMRETE d1AW1�B�OW%�' <br /> SIGNED% `•1.Ai ^�'d/ yL_,L•JT/EAI/ — W L� <br /> ROT PIAN IDMW TO SCALLS SCALE <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DHMSAL SYSTEM OR FIICIMSEO <br /> Z. OUTLINE OF THE PROPERTY.WNH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOBAL SYSTEMS. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND FROROSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADAUG OF ONE HUNDRED FIFTY FT.ON <- <br /> INCLUDING COVERED MEAS SUCH AS PATIOS.DRIVEWAYS,AND WALKS. THE FFOPERTY OR ADJOINING FORRTY. <br /> ® p <br /> I <br /> L <br /> / 3 r7- <br /> 6o Irf PAYMENT <br /> PEC:IEIVED _ <br /> e F r NOV 18 1997 <br /> I SAM JOAQUIN COUNTY <br /> J_✓.�'.( � - - <br /> PGBLJCFEEAt.TN SERVICES... <br /> �.,•e�nu..�.n.� uurru lnnncual <br />