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PERC TESTRI I I HOW MANY ApplImlIon YA- rS''p APPLICATION FOR LIQUID WASTE PERMIT SAN 10AGUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX sea, 304 EAST WEBER AVENUE, STOCKTON, CA 95201-388 (209) 4813420 11. NON.REFUNDABLE PERMIT EXPIRES 1 YEAR ERQIII DATE ISSUED (Ceramists in Id/silents, APPucKnoN IS HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDiOR INSTALL THE wont MICR:BED. THIS APPLICATION IS MADE N/ COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE. CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENEAL HEALTH DIVISION. tvl ANTE-CA Jos ADORESS/OR ARM °CIS q ER ST 14 wy CITY LOT SIZE OWNER'S NAME IAR 1-; e/L C- ADDRESS o. Bo)c tz.(47_ K_D A L-E (-7=+ • PHONE CONTRACTOR S 6LT-- ADDRESS 5/4m r SUS CONTRACTOR ADDRESS IJCP FROEKF 2 -8639 PHONE TYPE OF SEPTIC WORIC NEW INSTALLATION 1:1( RIPNIVADDMON C DESTRUCTION 0 NO SEPTIC SYSTEM PERMITTED IF MAIM SEWER IS AVAILABLE WRIIIN 200 MET OF SUIUNNO.1 INSTALLATION WILL SERVE RESIDENCE 0 COMMERCIAL NUMILEFt OF LIVING UNITS, n NUMMI OF NEDROOMS: 5 CHARACTER OF SOIL TO A DEPTH OF 3 FEET: SA /OD SEPTIC TANK/ASE TRAP EZITYFE/SAFO /27E, PRO TREATMENT PLANT q DISTANCE TO NEAREST: WELL LIFT STATION 0 SIZE TYPE OF PUMP LEACHING ONE pE NO. 8 LENGTH OF Liuss 2.. — FILTER BED 10 WIDTH LENGTH DEPTH MOUNDEb 0 WIDTH LENGTH DEPTH $EEPACEE 8115 0 DEPTH SIZE NUMBER DISTANCE TO NEAREST, WELL FOUNDATION PROPERTY UNE SUMPS 1:1 WIDTH 7 LENGTH is• , DEPTH /0 , INSTANCE TO NEAREST: WELL i3o FOUNDATION 2 ,e2 e•PROPEKEY UNE 30 DISPOSAL PONDS 0 mom LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE f HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WELL BE DONE IN AccoRDANCE WITH SAN JOAOUN COUNTY ORDINANCES ANO STATE LAWS. AND RUM AND REOULATIoNs or rme sAN JoAousi COUNTY. HOME OwNER OR LICENSED AGENTS =NATURE CERTIFIES TRE FOLLOWING: 1 CERTIFYTHAT IN THE PERFORMANCE OF THE YVON( FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMFLOY ANY PERSON PH SUCH A MANNER AS TO BECOME SUBJECT TO WORKNLAWS COMPENSATION LAWS OF CALIFORNIA. CONTRACTOR'S HI/ENO OR RN SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: I CERTIFY THAT MI THE PERFORMANCE OF THE WORE FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO k WORKMAN'S COMPENSATION LAWS OF CAUFORNIA.• THE APPLICANT MUST CALL 24 HOURS DJ ADVANCE FOB MI. NOMNRED DIAPECTIONII. COMPLETE DRAWOM BELOW. TITLE: octi SIGNED X DATE, PLOT ELAN PLAN DRAW TO SCALE) SCALE IS OTHER 0 ASK" -105 NUMNER Of INNELOYEZS. 5 PIT /SUMP SON. CHARACTER: E.? P WATER TABLE DEPTHL 3 0 / CAPACITY efaiHir42 /ao FOUNDATION NO. COMPARTMENTS PROPERTY LINE .2)0 SAND OIL SEPARATOR (ENCLOSED SYSTEM *- / DISTANCE TO NEAREST: WELL / 3 0 FOUNDATION /5-3. PROPEffrY UNE PROPERTY UNE DISTANCE TO NEAREST: WELL DISTANCE TO NEAREST, WELL FOUNDATION FOUNDATION PROPERTY UNE 35- I. NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. OUTLINE OF THE PROPERTY. WITH DIMENSIONS AND NORTH DIRECTION. DIMENSIONED OUTLINES AND LOCATION OF ALL EXUDING AND PROPOSED STRUCTURES. EiCLUDING COVERED AREAS SUCH Al PATIOS, DREW/NAYS. Alto WALKS. 4, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED EXPANSION OF SEWAGE DISPOSAL SYSTEMS. N. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. ON THE PROPERTY OR ADJOINING PROPERTY. ... . • . 3 441 21.900 4.4 . VT:Pg44:005 ,_ffss 5 -04,o .k . Di.- wog • Its;0 4 .5.4/17P 2SC 1(2,47PD „ . . Le.; tIod litAf z • 2 15° eoc..V.. • PAYMENT,- " 14Frg.ptimP" EA 5 V 0 tvii" :AP'(-41jBL ::'ePt4i.'R.2,:. 4 19;9H- vStr;viti-cukt. /VCIAQUIrK Lajl..f.'N I f . . .. ....... ....... /Km DEPARTFAENT use ONLY APPLICATION ACCEPTED BY ... DATE: :r Ni/9f 174- TANK, MT OR SUMP INSPECTION BY INISPEgjED, INSPECTION By ADDITIONAL COMMENTS: q- --2 4-1 Cp n-fa - imeati . 14 11 f fel P.*" ' I. - II Moll 14 0707 AREA: 2 /9 DATE ACcoUNITINI ONLY: AIDE PAC/ qe r 1 410 / rtecEiVED BY DATE SR / PERMIT NUMMI INVOICE $ Tz, PE CODE g501 FEE INFO 2<51P AMOUNT REMITTED ASV --- fèAeaH