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IT <br /> APPLICATION FOR LIQUID WASTE PERM <br /> AF!>[ /JAAAF" <br /> SAN JOAQUIN COUNTY PUBLIC HEALTFI SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Momplot! In Trlpfieatol <br /> APPLICATION 18 HEREBY MADE TO THE BAN JOAWIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH SAN <br /> JOAWN COUNTY DEVELOPMENT TRTIUSL CHAPTER 9-11110..3 AND THE WANDAPDB F BAN"AWN COUNTY PUBLIC HEALTH SERVICE-.ENVIRONMENTAL HEALTH DI -- <br /> JOB ADORESB/OR AM' //�-/T/�JV'-' ✓✓ • �9:7,�/n��� /� CRY /� /�LOT SIZE ' <br /> OWNER'S NAME '1I/�M -/`�✓ a'kS�C ADDRESS //'-'/"/"�"{- ,/ R10NE +'-/� &Z-3 73/,O <br /> CONTRACTOR - /✓/ TTM �� E'-� ADDRESS �2- C.��LK'�L�� / �!�UC/ T PHONEY J Y <br /> SUB COHTRACTOR ADDRESS LIC, PHONE <br /> TYPE OF SEPTIC WORK: NEW IN$TALLATIO REP IMADDITION El DESTRUCTION ❑ <br /> JIMM"M SYSTEM PERMITTED IF PUBLIC SEWER IS AV BSE WITHIN 300 FEET OF SUILDING.1 PERC TE•TIN 1 1 NOW MANY <br /> AppSeaSee P <br /> INSTALLATION WILL SENE: RESIDENCE!J COMMERCIAL ❑ OTHER ❑ <br /> NUMBER OF UVING UNITS / MUN EI OF{EDROOMI: a NUMBER OF EMPLOYEES: / <br /> CH ER OF BOB.TO A DEPTH OF]fEET. t PR/SUMP 606 CHARACTER: <br /> C �Qpgn� WATERTABLEDEPTH 7D J <br /> •ETC KATIREASE TRAP ❑TYPE m / Tu-C' - CAPACRY NO.COMPARTMENT <br /> WO TREATMENT RANT[:IDISTANCE TO NEAREST: WELL ©"' It <br /> fOUNDATDN S PROPERTY UNEL�O f� <br /> UFT STATION❑ SEE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEMI <br /> LEACHING UNE NO.S LENGTH OF UNE,g- 170 "��'� DURANCE TO NEAREST!WEU,&+ FOUNDATMN PROPERTY UNE <br /> FILTER RED LJ WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATgN PROPERTY UNE <br /> MOUNDED pq❑MOTH UMTH DEPrN DI <br /> �7 DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> SEEPAGE RTS DEPTH WE� R_NUMBEe9- STANCE TO NEAREST:WELL IQ,l FOUNDATION 1 I PROPERTY UNE / <br /> SUMP ❑WIDTH IFNOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL FONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION Pr1DFEATY UNE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APFUCATION AND THAT THE POOP(WILL BE DONE IN ACCORDANCE WITH BAN JOAWIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REAULAYONS OF THE BAN OUNTY.HOMEC ERORLICFNBEDAOEHT'8-bNATURECERRFIESTHE FDLLOWINO:'I CERfIFYTNATNTHE R1iO1MANCE OF THEN9IK FORVAIICH <br /> TMB pE B mm1ED 1 SH NOT EM y AM'PELlBO N BIICN A MANNER AS TO BECOME SUBJECT TO WOPKMAH'B COMPENSATION LAUW OF CAUIORNIA.' CONTRACTOR'S HIRING OR <br /> SVB-CD T AT ERTNTE- R THAT IN THE pETFORMANCE OF THE WORE(FOR VMICH TMS PERMIT IB ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO <br /> N I I <br /> WORK AN'B N TEN! TI WS OF C II1. i M ART MUST CALL 34 NOUIS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPETE DRANO BELOW' <br /> TURF' <br /> - DATE /D_ ]I-S7 <br /> Bq % <br /> ROT RAN DRAW TO SCALE)SCALE_ 'Re <br /> �. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> t. NAMES OF ST ADS,NEAREST IO OR BOUNDING THE PROPERTY.V. E%PAN810N OF SEWAOE DISPOSAL SYSTEMS. <br /> i. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. S LOCAMN OF WELLS WRILIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> J. DIMENSIONED CO EREDAR AND LOCATION OF ALL IVISTNO AND PROPOSED STRUCTURES, THE PROPERTY OR ADJONINO PROPERTY. <br /> INCWDINO COVETED APiJ1B SUCH AS PATro�BT,,DPVEWAYe AND WAUCe. <br /> A,rR.rN'T.E Gtr Sp1...ItD1 <br /> A <br /> �-- <br /> P' <br /> KB�h <br /> . .... <br /> :.... . . c� p WENT <br /> C. REC EWED <br /> 00T...31197; <br /> ....��ira.GOLINTY. <br />