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APPLICATION FOR LIOUIO WASTE PERMIT <br /> BAR JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,446 IL SAN JOAQUIN BY,STOCKTON,CA 96201.0388 <br /> (20%468-3420 <br /> NOIFREFUNOABLE PERMIT EXPIRES 1 YEAR FROM DATE I$$VED <br /> (Coavim is Triplicate) <br /> Application Is hereby rade to the San Joaquin County for a permit to construct and/or install the work described. This app{ication <br /> is made in compliance with San Joaquin County Development Title, Chapter 9-1110.3 and the Standards of San Joaquin County Public Heelth <br /> Services, Environowntat Health Division. D <br /> Job Address/or APN# 'ac R I1 —­7Aozon,,21— i2c City Lot Size <br /> Owner's l Name AA 1 t (XV—V lAy Address��� Phone aaD-3W <br /> Contractor 4o, Address lZI >Y(+: yd_&4+ LIcA --30,0 1 I phone=Wa, <br /> Sub Contractor Address Lic# Phone <br /> TYPE OF SEPTIC WORK: NEiN INSTALUTION I REPAIRIADDITIONDESTRUCTION II PERC TES141 II Haw wast <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) <br /> Land Use Application# <br /> Installation will serve: Residence_ CommerciaLOther— <br /> Number of living units;^ Nuuber of bedrooms:_ Number of employsesr,�Q�.„'+-1.=� <br /> Character of soft to a depth of 3 feet:r)a-r Pit/sump soil character: �Water Table Depth <br /> SEPTIC TARK)ONEAIE TRAP i] Type/Mtg Capaclty No. Compartments <br /> PKO TREATMENT PLANT ( 1 Distance to nearest: wail Foundation Property Lira <br /> LIFT STATION U Size_ Type of Pusp Sand Oil Separator (enclosed system) <br /> LEACHING LINE Pf No. & length of Distance to Nearest: Wet kcZW� Fourdatlon­2gLL_Property Lin - <br /> FILTER BED [] Width Length Depth Well Foundation Property Ltna <br /> MOUNDED (3 Width Length Depth Well foundation Property Linty <br /> SEEPARE PIT$ 0- Depth-7S Srize -34,”Nurber s We L./ r foundation_3aL Property Lines ' <br /> SUMPS r) Width Length Depth " " Welt FoudationProperty Line M <br /> DISPOSAL PONDS [] Width Length Depth " " Welt Foundation Property Line -+ <br /> I hereby certify that I have prepared this application and that the work wilt be done in accordance with San Joaquin County Ordinarw:e `� <br /> and State Laws, and Rules and Regulations of the San Joaquin County. Hoar owner or licensed egent'a signature certifies the followirJ`l; <br /> "I certify that in the performance of the work for which this permit is issued, I shall not eaptoy any person In such a meaner &r <br /> to becoau subject to worknan's compensation laws of California." Contractor's hiring or sub-contracting signature certifies thp,- <br /> following: "1 certify that in the performance of the work for which this permit is issued. I shall employ persona subject to workmen' <br /> compensation laws of Catifornis." <br /> The appluat mast call 2�=-7* <br /> ed Nsrpeetiame. Complete drawing below. '- <br /> Signed X R a1/1 Title: n in rl Y�� Date: /�.-$'-`7� <br /> PLOT PLAN (Draw to Scale) Scale " to <br /> 1. Namara of streets or roads nearest to or bounding the property. 4. Location of house sewage disposal system or <br /> 2. Outline of the property, with dimensions and North direction. proposed expansion of sewage disposal systems. <br /> 3. Dimensioned out H nes and location of all existing and proposed 5. location of wells within radius of 150 ft. an <br /> structures, including covered areas such as patios, driveways, the property or adjoining property. <br /> and walks. <br /> (� <br /> LZ <br /> I <br /> j <br /> v GI <br /> EC 1994 <br /> gin, wu Ul C4 c <br /> FOR DEPARTMENT USE ONLY <br /> AFplio��_[[[at'''ion Accepted by Date: <br /> Z Area `L= Zi <br /> Tuck, Igor Sump Impaction by ateL�� al Inspectfoh sial /`� ' <br /> Additiomt Convents: <br /> ACCOUNTING ORLY: AID# FACN <br /> PE CODE fEE INFO AMOUNT REMITTED CASH RECE[vEa BY DATE SR i PERMIT NUMBERS y INVOICE/ <br />