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APPLICATION FOR LIOUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 45202 <br /> (209)468.3420 <br /> NIAREFUNOAPEE PUMT EXPIRES 1 YEAR FROM DATE 19?UED <br /> Cowip B M Tr*mW <br /> ANOCATON IS HEPEEY MADE TO THE BAN JOAOUMI COUNTY FOR A PERMIT TO CONSTRUCT ANO/OR INSTALL THE WORK OESGPMED.THIS APPLIGLTON W MADE IN COMPUAW.:E MATH BAN <br /> OJOWBNIEWB ^ RVICEB. 11AINTJOAQN COINTY bEVEARA T R&1110 STANDARDS OF BAN JOAAN COUNFUSLK HEALTHEHEALTH OMSION. <br /> ADDNEBBXy <br /> CRY �r <br /> T S2� <br /> NN1l 4A( Y12--o2nL <br /> L <br /> CONTRACTOR GADDRESS UC# PHONE <br /> SUB CONTRACTOADORE r2 CALtAaW V. J/'7' UC/�Ff PHONE <br /> TYPE OF SEPTIC WORK: NEW NBTAUAM pE;pARIAOINTION CI DrATRUCDOM❑ <br /> SVO SEPTIC SYSTFJA PETSARTEDIF PUBLIC GEVvER IB AVAS.ABLE WITHIN ,,FEET OF BUILJ7..M.1 FDIC TLTIPI I)IIOLB YAMT <br /> APP\PPsw# <br /> NSTALLA710M WILL S/iNG RESIOETICE COI.MI.AL❑ OTHER❑ <br /> MUM&M OF UNMO ONSTs: NIAHMR OF Bm"D 4, -3 w^ftm OF ENImovw: <br /> 1T� �r..X 1 `P— <br /> EA OF SOFT TO A 1,I OF J RET: PfTfelN✓tp BOLE CRARACTEfI WATER TAKE DEPTH <br /> sync T E TRAY ❑TYPEA`4 `E_r�C.+-0r cAPACRY. C9O No.COMPA/AMINTB r) <br /> MCO TREATMENT FLAAT❑ DISTANCE TO MFAAEBT: WELL WUfAATIDN PROpurry UNE <br /> LFT STAMM❑`,..ESPUL <br /> A?TYPF OF P SAND ONE SEPARATOR(ENCLOSED SYSTEM) <br /> L.EACIE/T6 UNE `y4 NO.\IINOTN OF U"3 —0 r INSTANCE TO/NEAREST:WEU- ED TgN f� r � N <br /> PRO ERTY UNE <br /> FILTER SED ❑WIDTH LENGTH- DEPTH DISTANCE TO NEAREST:WELL FOVWOATION PROPERTY LIME <br /> AIOUMOm ❑T�I LVRDTH LDwN— DEPTH U <br /> DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY NE <br /> 801-09 RTB LJ DEPTH SIZE —NW.IBER DISTANCETONEARESTUWELL FOUNDATION PROPERTY LINE <br /> WANK ❑WROTH LENGTH__OF"" DISTANCE 70 NEAREST:WELL_FOUNDATION PROPERTY UNE <br /> DISPOSAL POMDS ❑LMDTN LENGTH OFFrH DISTANCE TO NEAREST:WELL FOUNDATION PROFfFtrY UNE <br /> 1 HERESY CERTIFY THAT 1 NAVE PREPARED B APPLICATION AND THAT THE WOR(WILL BE DONE N ACCo1DANCE Y1TTN SAH JOAOLN COUNTY OIOMANCE7 AND STATE LAWS.A, ISl[[B <br /> AND RCODUTIONB OF 711E PAH JOAOUIN NTY.HOMEOWNERORUCCNBEOAGEMr'SSONATLMCEKnM*Tk[FMLO`MVO:ICOMFYTHATNTHEPEVWOWANCEOF7WVYDPKFORWHKH <br /> ,/TN Ftl0.0T 1B 1 NOT EA v ANY 1ERWIN N NCH A MANNER AS TO BECOME SUBJECT TO WORKUNfB COMPDWATON IAWS OF CALFORNIA.'COM/NCTOR•S HMWB OR <br /> SU f E A It <br /> CERTIFIES FOLLOWING:7 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOA WHICH THIS PERMIT IS ISSUED.1 MALL EMPLOY PUISONS SUBJECT TO <br /> NOIEL 1 B T LA— A.' THE AP"M"T MUST CALL G,HOISRS N AOVANCS REMLIwm IMSPEC7IOMs. COMPLETE OMEMNG ftajjOW. 9 <br /> `\\\\SUMMMED X +4 ` f TITLE DATE: `•'r •� / <br /> PLOT'LAM IOmw To SCALL?SCALE ro <br /> 1.HALIDE K OR POADD NFARE8T 70 OR BOUNOIM1IO THE PPIDPEIITY. 4,LOCATION OF HOUSE SEWASE DISPOSAL SYSTEM OR PROPOSED <br /> Z.OV MJE PROPERTY.WITH dPAENB10N8 ANO NORTH ow—cu (. EXPANSION OF SEWAGE DISPOSAL SYSTEM. <br /> �. DIMEHOONEO OUTLINES AND LOCATION OF ALL EXWnNO AND PROPOGEO STRUCTi EES. E.LOCATION OF VAT A NTTHIN MOOS OF ONE HUNDRED FIFTY FT.M <br /> LNCLUOP/G COVERED AREAS SUCH AS PAT108."VEWAYS,AND WJ1N8. THE PROPERTY OA ADJOINING RWKRTY. <br /> ... ...... .. ... <br /> .......... .. AAAA. AAAA e ... <br /> ._........... Sr¢ D .-.. _ <br /> AAAA. <br /> t <br /> :,AAAA <br /> �...... <br /> AAAA... .. .. ... AAAA.. �P _._._ .. <br /> .,AAAA.., <br /> ......... . <br /> AAAA; <br /> �. ...............?AAAA_ .,...._.... <br /> ..:............. . .. j�ll@:t mp AAAA... <br /> :.................. AAAA.L... <br /> AAAA AAAA . <br /> Flo <br /> ........................ .I. <br /> .. . . , AAAA... .. <br /> A.; <br /> AAAA. ... <br /> .....:..... <br /> . :......;.._:.......... °.._ ,....�......�AAA .. <br /> � ;........ .. AAAA. , . .. <br /> Lv .... (S� <br /> AAAA <br /> .....:.......:........._... ..s:..........Pr-...:...... AAAA.. ._..........+ � _ <br /> t AAAA AAAA... <br /> .................:....: AAAA <br /> :......_.....,. ;• ..AAAA <br /> :. <br /> ............. . .._AAAA. . <br /> • • .. AAAA <br /> .. AAAA... <br /> o. � <br /> •• , .. _ ... AAAA . AAAA <br /> AAAA <br /> AAAA ::iar.1/, <br /> :... ,AAAA..: .:.. .... :.............. Nnnt rr <br /> .............t... t ...,n:Vlp(1 ...fit L 181QN..;,. <br /> wrg <br /> roR OVARTP#ENr wroncr <br /> APPLICATION ACCEPTED BY ]DATE: <br /> TANK,NT OR SUMP INSPECTN(4 DATE 1 I FINAL IHSPEC7ION BY TE ,3d , <br /> ADDITIONAL COMMENTS: <br /> ACCOUNDMM OILY: AID# FACI ,�DINGO <br /> A GOW FAX INEO AMOUMt.IiYD kl ASH R¢evw BY DATEAl NlPHpeT Mls1O� IMVOICEI <br /> -2- <br /> Flub. <br /> Flub.HORkh&IY.-En"10.174(31S6) <br />