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�d NA .G• w APPLICATION FOR LIOUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH-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 /> ICimPIEtR in Tr4FiwtE1 <br /> APPLICATION IS HEREBY MADE TO THE SAH"AWN COUNTY FOR A PERMIT TO CONSTRUCT ANDPOR INSTALL THE WOM DESCRIBED. THIS AWIICATION IS MADE IN COMPLIANCE WITH BAN <br /> 4 "AWN COUNTY DEVELOPMENT IFRILL�CCHHJAFTER S-11110,3 AND THE 6'TANDARD8 F SNI.roAWIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMEMK HEALTH DAAMN. <br /> JOB ADDRE6WOR AM' /TvckIx'' '4 7;5 �n -CRU �� LOT SIZE' -e <br /> OWNER'S NAME '1IA/oJ�L ` a-LS-e— ADDRESS s ' / RIONE lie&-3 730 <br /> ADDRESS ?2 F C�Lw'LG��I/ �IIC/ T Z2 ,HONES 5343 <br /> SUS CONTRACTOR ADDRESS UCI PHONE <br /> TYPE OF SEPTIC WOM: NEW INITAOATIO It ADVADDITION ❑ <br /> NPTDFyTRUOl10X 13O SEPTIC SYSTEM PERMITTED IF PUBLIC 6'EVYER IB AV WITHIN 200 FEET OF BUILDING.) PDIC TESTHI 1 I HOW MANY <br /> ' \�///�' App6wUen <br /> INSTALLATION WILL fUEVE: RESIDENCE {J COMMERCIAL ❑ OTHER ❑ <br /> MONISM OF UVIMW UMTS: NUM ER OF SEDROOMS' 1), MONISM OF M OYEES: / <br /> C ER OF 608 TO A DEPTH OF]FEET. Lift PR/SVMP 60M1 CNARAREA. <br /> /gpO� WATER TABLE DEPTH <br /> iEPIIE KIOIEASE TRA) ❑TYPENAFG - CAPACITY NO.COMPARTMENT <br /> PRO TREATMENT P W❑ DISTANCE TO NENIUT: WELL 62!� FOUNDATION ' PROPERTY MELS <br /> OFT STATION❑ 612E TYPE OFFr YMOP <br /> /��SAND OIL SEPARATOR(ENCLOSED SYSTEM) / <br /> LEACHING ONE J}��-L,T�-HO.S LENGTH OF ONES IOL- -•e • '�t � DISTANCE TO NEAREST:WELL/BU L FOUNDATION /O gW{4RTY UNE <br /> FILTER SED LJWIDTH LENGTH DEPTH MSTANCE TO NEAEET:WELL MUFIDATIDN RWPERTY ONE <br /> MOUNDED pp❑MDTH LENGTHDEPTH NSTANCE TO NEAREST:WELLTOUNDATION PROPERTY ONE , <br /> SEEPAGE NTS SIZEM <br /> MONISM L9- DISTANCE TO NEAFET:SWELL/49' FOUNDATIONS PROPERTY ONE l0 CD <br /> ONE <br /> SUMPS /❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION FTIOPERTY <br /> DI6roSAL FONDS ❑WIDTH LEN ITN DEPTH OUTANCE TO NEAE6T:WELL FOUNDATION PROPERTY UNE <br /> - <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE NTTH SAN JOAWIN COUNTY OMNANCES AND STATE LAWS.AND RIII.ES <br /> AND REGULATIONS OF THE SAN OUNTY.HOMED ER OR UCENBED AGENT'S SIGNATURE CERTIFIES THE MOLDWNG:'I CERTIFY THAT N THE FE1iO1MANCE OF THE WOM FORWHICH <br /> THIS E ISSUED,I EH NOT fM Y ANY PERSD SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPFNEATION LAWS OF CAW011MA.' CONTRACTOR'S HIRING OR <br /> 6UBLb T A ERf61E8 E THAT IN THE PERFORMANCE OF THE NOW FOR WHICH THIS PLPAM IS ISSUED.I SMALL EMROV PERSONS SUBJECT TO <br /> RI Ii <br /> UAW. AN'E 1. NS TI 1 WS OF C IA.' TIF {TICART MUST CALL H HOURS IN ADVANCE FOR ALL REWIRED INSPECTIONS. COMPLETE DRAWING B <br /> TITLE: <br /> �.'I - DATE: /0- 3i-S F <br /> BIO X <br /> MOT PLAN IDRAW TO 6CALE1 SCALF_ I° <br /> 1. NAMES OF Ef ADS NEAREST TO OR ROUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OWME OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DIEPDSK SYSTEMS. <br /> 3. DIMENSIONED WILMES AND LOCATION OF ALL EXIfFIM AND PROPOSED STRUCTURES. 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> UN LU LNG COVERED AREAS SUCH AS PATIOS,DRIVEWAYS AND WALKS. THE PROPERTY OR ADJMI NG PROPERTY. <br /> -rn d,t <br /> ,Q <br /> w.IN S, s . <br /> - - <br /> _. NBrL�iG_. <br /> GLIA C� <br /> P XMENT <br /> MOWED <br /> OGT 31;197 <br /> w GbUNTY <br />