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A WD[IMOOR LIQUID WASTE PERMIT <br /> V�jcw4; N C NTY PUBLIC HEALTH SERVICES <br /> ,I COlITN' �TaID1 IR ENTAL HEALTH DIVISION <br /> SLAY jCn�1R0 WEBER AVER,STOCKTON,CA 55201388 <br /> (208)488.3420 <br /> ]L1� NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> McNpMu In TrIpkatsl <br /> ��q�"NA ATION IB—Y MADE TO THE SAN JOAQUIN COUNT('FOR A PERMIT TO CONSTRUCT AN 11 INSTALL THE WORK OESCRIBEO. THIS APPLICATION IB MADE IN COMPLJANCE WITH BAN <br /> JOROVIN COUNTY DEVELOPMENT TATTLE,CHAPTER�S•)1 110.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PIJBLJC HEALTH SERVICE*,ETMRONMENTAL HEALTH DIVISION. <br /> JOB ADDRESSIOR API/ 1''/9, q,{ Iy /`yLC/L� 17- CT{�' L ( LO'T/WZ-F2'�"1 <br /> OWNER'S NAME �ri(.�.0 K.. Jai&a40��� ADDRE. /i,/ PHONE �'I—Gl I z- <br /> CONTRACTOR_ (lTyl//yL AGGRESS Z� dR'� UCF__IZ�r�1 LN/OFIE.4��a3 S3f/3 <br /> SUB CONTRACTOR �'— ADDRESS UCS PHONE <br /> TYPE OF 8I0`11C WORK: NEW INSTALLATION❑ RFPAIR/AODIPON DEATRUCTIGN❑ <br /> NO SEPTIC SYSTEM PETMITTED IF PUBLIC SEWER I*AVAILABLE WITHIN 200 FEET OF* KDINO.I P91C TESTIH 1 1 NOW MANY <br /> 1�f APF/wtlon <br /> BER <br /> VE:WILL BEI [: RESIDENCE a/pv COMMERCIAL❑ OTHER❑ <br /> NURSER OF UVWO UNITS:_NUNISEROFSEDROO(Fj�: �MUM*91 OF IMKOVIES:��_ <br /> CHARACTER OF SPL TO A DEPTH OF 7 FEET: 1RN-yL. PFT/SUMP SOIL CHARACTER: .K.WATER TABLE DEPTH <br /> SEPTIC TANIVORKASE TRAP ❑TYPEWFIT CAPACITY NO.COMPARTMENT* <br /> PKO TREATMENT RANT❑ DISTANCE TO NFARE$T: WELL FOUNDATION RgPI!Fv LINE <br /> LIFT RATION❑ B2E TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEMI (OS <br /> LEACHING UNE �.I/NO.R LENGTH OF UNE* ;Z—O O �'1-.Asp DISTANCE TO NEMER:WELL FOUNDATION �PROPERTY UNE�� <br /> FTLTm SED (❑MADTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEARER:WELL FOUNDATION PROPERTY UNE <br /> SHPAOE FITS ❑DEPTH SIZE NUMBER DISTANCE TO NEARER;WELLFOUNDATION PROPERTY LINE <br /> SUNIM wKY1H LENGTH_DEPTH DISTANCE TO NEAREST:WELL FOUNDATKTNIeO_PROPERTY UNE_ <br /> DISPOSAL POND$ ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIe APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORMNANCES AND STATE LAWS,AND RULES <br /> AND REOULATPONS OF TIE BAN JOAOUN COVNrV.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWINO:'I CERTIFY THAT IN THE PERPOMMANCE OF TM WOW"WHICH <br /> THIS PERMIT M 1 SUED,1 SHALL NOT EMPLOY ANY PERSON IN CN A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HMSNO OR pQ <br /> SUB-CO TING ON C I THE FOLLOWING: C THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMT IB ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WOTKMA '6 COM TION we C UFORNI T CALL 34 HOURS M ADVANCE FOR ALL 11EOUBIED INSFEOTIONI.COMPLETE DRAWINO BELOW. <br /> SIONEO z TITLE101� DATE: <br /> ROT MN(DRAW TO SCALE(SCALE 'to <br /> 1 NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMEMBONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL BYREMS, <br /> 3. DIMENBtomm OUTUNEB AND LOCATION OF ALL EKISTWO AND PROPOSED STRUCTURES, S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNOPED FIFTY FT.ON <br /> INCWDING COVERED AREAS SUCH AS PATO$,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOENINO PROPERTY. <br /> r �Z _ <br /> _ IQs <br /> Pf <br /> � ...... . <br /> To../cQLcua,. <br /> N <br /> . . . <br /> . ..... <br /> 01996 <br /> .. y:x.8.xto . <br /> ,.ESL SAN <br /> aqUIkcQCNTr <br /> PUBLIC HEAiTH$EfiVICES <br /> . <br /> . IR NNfTTTRt i'iEAL%H f31VfSIpN <br /> , POR OBARTMENT WE ONLY -7 <br /> APPLICATION ACCEPTED BV DATE. r C.1C <br /> TANK.PIT OR SUMP INSPECTON BY DATE I I /FINAL INSPECTION BY <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING ONLY: AID( FAC/ <br /> PE CODE FEE INFO AMOUNT REMITTED CHECK/ ASH RECEIVED BY DATE SR I PERMIT Nume LR INVOICE <br /> SR o00 <br />