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DOv G;Y APPLICATION FOR L1OUIO WASTE PERMIT SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P,O.BOX 988,904 EAST WEBER AVENUE,STOCKTON,CA SMI-38B (2091 480.3420 N01-REFUNPOLE PERMIT EXPIRES T YEAR FROM DATE ISSUE➢ {CPmp6t&16 Trlplkaai APPLICATION IS KREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMrT TO CONSTRUCT ANZ11 INSTALL THE WORK DESCRINO.THIS APPLICATION 16 MADE IN COMPJANCE WITH VAN JOAOUM COUNTY CEMOP�nM7 ENT TrtLE•//CHAPTER 9-1170.3 --T T 70.3yAND THE STANDARDS OF SAN 00AOU0I COUNTY R1/UC HEALTH SERVICES.EN1M10NMWTAL HEALTH dU6'ON. JOB ADDRESSIOR APN+' -q 310,6 O So• 1 Q„�L'M (� CITY F}� �T- >`SLL )�/� J�i/�i� �LOT SRF OMINEn'B NAME" R�1( �Qun hcR �A0O�85 �/4 R10NE CONTRACTOR '�� S� ADDRESS r c�'� LIcr?V l-3G3 SUS CONTRACTOR ADDRESS LICF —PHONE TYPE OF B&VTK WoREL NEW INATALLATION D REPARVADDITIOP+,I' DBTRUCTION 11 IND SEPTIC SYSTEM PERW11'IED IF PUBLIC BEV R IS AVAILABLE WITHIN 200 FEET OF BVILDRIG.1 PYIC TWThi[1 RI"MANY ApP11aSbP./ INSTALLATION WILL.KNE: RESIDENC&Zr COMMERCIAL❑ OTHER CT r NIIMKR OF LNK 1N-UNITS! / NUMR W SEDROOMS: ✓'j NUMBI1 OF EMPLOYEES:I- � a CHARACTER OF 901E TO A oEPTDEPTHCF-7L FC/,4EET: � g p1TJSUMP BOIL CHARACTER: �'�WATER TANI DERH /fj 'I3 6 SE►RIC TANKIOREAU TRAP lALVP FaIT `--�CU}�G, CAPACY �;200 NO.COVRARTYENTS +� FY WO TREATMENT PLANT Cl d&TA1/Ci 70 NlMftT: WELL /&O'T FOUNOATiON yitQ` RIDTqRTY'UNE /0, LFT STATON 1 1 SSIIZE TYPE OF/POMP BAND OIL SEPARATOR IENCLOSEO BYSTEMI LEACHING UmW HO.-LINOTH OF LW ES t` OV DISTANCE TO NEAREST:NAL 1,061 FOIJNDATTON—LL-PROVER1Y LINE FILTER SED ❑WIDTH U-MTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION_ / PROPERTY LINE .� MOUNDED ❑WIDTH LENGTH__DEPTH DISTANCE TO NEAREST:WELL _FOUNDATION PROPERTY UNI mCI & AOE MTS DEPTH BIQE RAMMER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY tR/E U' &UMW tr.11TH _LEN071 {?!! DEPTH 7' DISTANCE TO NEAREST:WELL FOUNDATION_PROPERTY UNE MOPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:,N1L_ FOUNDATION PROPERTY UNE �1 I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THf.WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUSR COUNTY ORDINANCES AND STATE LAWS,AND RULES Q AND REGULATIONS Of THE SAN JOAOUIN CMWTY.HOME OWNER OR LICENSED 060EN7'S SIGNATURE CERTIFIES THE FdLLOWM:-i CERTFYTHAT M THE PERFOMANIM OF THE WORK FORWHKH {F., THIS PERMIT I&16SI/E0,I SHALL NOT EMPLOY ANY PEROON M SUCH A MANNER A�..sO.4ECOME SU CT TO WOFKMA W R COMPENSATION LAWS OF CALFORW IA.- CONTRACTOR'S WRHG OR SUI CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:•I CERTIFY THAT ,HE PF/AfORMANC F THE WOW FOR WHICH THIS POWrT IS ISSUED.1 SHIALL EMPLOY PERSONS SUBJECT TO I WCRKMAN,6 COiL��,4z SATION UF011NtA�7ANI�r!10 A''L!LL__HOUR{I ADVANCE POR/A,LLLL PRb,OILJ�WJM INNGPMTITIO�. COMPLETE DRAWING BELOW. 9 ` Al 61GNE0 z Lam^ TAE: V/^L/�/(fes "'� DATE: f - PLOT AN(DRAW TO SCALFI SCARE 10 - 1.NAMES Of STR REETS OR ROADS NEAREST TO OR SOUNDING THE PRDPERrY. E. LOCATION OF LOUSE SEWAGE DISPOSAL 6YSTEM OA PROPOSED i 2.OUTLINE OF TEN:PROPERTY,WITH DIMENSIONS AND NORTH DIRECT*%, EAPANSON OF WWAOE dRORAL SYSTEMS. 3. OWEHLIONED OUTLINES AND LOCATION OF ALL EXIIITIN0 AND PROPOSED 6TRUCTLIRES, F.LOCATION OF VALE&WITHIN RADIUS OF ONE RUMORED FIFTY FT.ON INCLUOING COVERED AREAS SUCH AS PATIOS,CRVEWAYS.ANO WAtAS. THE P'IOPEIT'OR AOJOIRREIO WIOPERrY. 4.r exlr AUG 2 - 1996 SAN 3A',L, PU8:1c HEA•7 ,-Cl ENUIRC1NMENr.�! FOR DEPARTMOIT USE ONLY Q I AM MATION ACCEPTED BY \ (Y✓1/?/I�LP��-p DATE:—g f AREA:_ TANK,RT OR SUWP INSPECTION SY DATE / ! FINK INSPECT DY �✓�'�•�"_`'�_U DATE 1 1 !-1�'J ADDITIONAL COMMENTS. ACCOUNT--ONLY: Al. FACE K CODE FEE NIFO AA1OlJIF7..IT[D CHEC /CASH RECEVLD SY DATE !FI IPEMET KAISER 11VVO10E P z 1 o S r a L16 g�9(v r 5-Z z