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i <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN.JOAQUIN COUNTY PUBLIC HEALTH SERVICES S� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SCC 304 EAST WEBER AVENUE,STOCKTON,CA 45IR <br /> I <br /> SEPP (209)468.3420 J��,�NED <br /> ` 101-REFUNDABLE ELSy EXPIRES i YEAR FROM PATE ISAVED /7 c <br /> f - ICu4Mh'AN TTlfltiNyw 0-/' <br /> APPLICATION 10 HEREBY MADE TO THE SAN JOAOUM COUNTY FOR A PERMIT TO CONSTRUCT DAR WSTAtL THE WOR%OEBCFBBE0.THIS APPLICATION 18 MADE IN COMPO NCE WITH SAN <br /> JOAOUIN COUNTY DEVELOPMENT TTTLE.CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOUM COUNTY PUBUC HEALTH SEIMCM ENVIRONMENTAL NEALTH DMIOq N. II <br /> Joe AppRE a OR APRs LOT SIZE <br /> //�� p <br /> I l ADORE PHONE_ C"o/_( r S <br /> CONTRACTOR fi.,I ,�:LL.L. gs ADDRESS ��--��,s, <br /> a" 'IV O LN:I��2fCLdh�/ �I <br /> 6U0 COMRAOTOR ADDRESS <br /> I AJC/ PHONE <br /> TYPE"SEPTIC WWW:- NEW INSTALLATION Rk4AFVADpTbk❑ DElTRIFCt10!/❑ <br /> DID SEPTIC SYSTEM PERMITTED IF PUBLIC SEINER 18 AVAILABLE WITHIN 200 FEET OF BUILDING. <br /> � 1 � PRC TLaTNI E 1 NOW MANT <br /> iNCTALLAT1pN WILL lBNE RE&DEICE Yy ff ODMMERpAL Q �r D,,ER AP~— <br /> ❑ II <br /> t NUMBER OF LIVING ygTS:_.�L_NuMea OF BEDROOM, �S NLya OY : <br /> I CHARACTER OF SOIL TO A DEPTH OF 7 FEET: <br /> PIT/el1MP 601E CFIIRRACTER: WATER TABLE DERH <br /> SEPTIC TANKX*Mur TRAP ❑TYPvMFO / <br /> CAPACITY NO.COMPAMMk71TB .,2 'I <br /> PIED TRE.UTMENT PLANT 11DISTANCS TO MERRIEST; WELy1GCfL�T FOUNDATION r�F r ppOpERry LINE <br /> 11fT!RATION El S12E TYPE OF PUMP BANp OR SEPARATOR SNCIOSED BYSTFJ./1 <br /> LfAcHM Vt T <br /> �S NO.!LENGTH OF UNE" "/D/J ��" DISTANCE To NEAREST: <br /> RLTR!ED wF11 �— PROPERTY UNE /'/ - ,�POUNDATION Q <br /> ❑WIDTH EENBTH DEPTH DISTANCE TO NEAREST:WCEI.FOUNDATION' PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPLN <br /> DISTANCE TO NEA1FSf:WELL FOU/DATbH fNIPCiRY LME I� <br /> lEBAOE PRS ❑DEPfk BRE NUMBER DISTANCE TO NEAREST:NEIL FOUNDATION <br /> P'RIOP'E7LfV LODE <br /> SUMPS ❑WIDTH LEWTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PRDFERTYLIW <br /> DU►OSAL POND! 13 WIDTH LENGTH DEPTH INSTANCE TO NEAREST:WELL FOUNDATION PROPERTY UTNE <br /> I HERESY CEOIFY THAT I NAVE PREPARED 7JSS APPLICATION AND THAT THE WOW WILL BE DONE N ACCORDANCE C) WITH SAN JOAOIIN COUNTY ORD,HANCES AND STATE LAWS,AND <br /> RULED <br /> -ANOIRFGIJLAT1D118 <TNE SAH JOAOM COUNTY.,HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES TIHEFOL10 Wp10:.7 CERTIFYTNAT W THE F47FORMAHCE OF THE WOgL F0P7 WHICH <br /> THIS PEIWLT IS ISSM,1 STALL NOT EMPWY ANY PERSON IN SUCH A MANNER AS TO BECOME SUSJE'CT TO MMMAN'S CO WENSATION LAWS OF CALIORMA.•CONTRA <br /> CTOKS H"""OR I <br /> VUSICO ITRACTING SIONATURE CEMVPES THE FOLIDIMNO:T CERTIFY THAT IN THE PERFORMANCE OF THE WORK POR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS BU6/ECT TO <br /> WOW MAN's COMPENSATION LAWS OF CALFORMA.-TK APPLICANT FMUST CALL 24 HOURS IN ADVANCE PDR ALL Xfi W vo tNSMMMS.COMPEM DRAM IO BELOW, <br /> STONED X_ _ / _ ./ TTTLE:—=�G�.�'G� -+ter DATE: � �r—�/ <br /> IQ, <br /> I <br /> PLOT PLAN MAAW TO SCALD SCALE •le 1r <br /> I.NAMES OF SREETS OR ROADS NEAREST TO OR BOUNDING THE PRiOPERTY. 4.LOCATION OF HOUSE OEWAOE 01WOBAL SYSTEM OR PROPOSED I <br /> 2.OUTLINE OF THE PROPERTY.WITH DIMDMWONS AND NORTH DIRECTION. <br /> E%PANOION OF SEWAGE OISPOBIIL BYBTDAB. <br /> 3. OSUENSIONEO OURUNES AND LOCATION OF ALL EI USTWG AND PROPOSED STRUCTURES, S.LOCATION OFVJE11B WITHM RADIUS OF ONE MR1PREDD FIFTY FT.ON �1 <br /> NCLUINNO COVEl1ED AIRF"SUCH AB PATIOS DgVEWAYS.AND WALLS <br /> .... .. .................. ........ _. <br /> PRO OR AQIONMG PR01"E1TTY <br /> .. ..... <br /> ... .. <br /> I <br /> 1 <br /> ...? i..... ...... ...;... .. <br /> .... ......J .......:.....' i <br /> !, 47 <br /> .i <br /> 5.....: .. a.... <br /> `..... ........ <br /> �. <br /> ..41. <br /> W <br /> �' ti 'F s� <br /> . f ... <br /> ...... ..... <br /> ........ <br /> ....... <br /> .... .DEQ.: Tom.' <br /> ',. ..... ...... <br /> tr131QL11N.L:61t <br /> v , <br /> ... .......... <br /> ... . ....... .. <br /> NVIPpo <br /> POR DUYW MENT USE ONLY <br /> APPLICATION ACCEPT DATE id -/ -� AREA:. /14 ,9pQ <br /> TAMC,PRT OR SUMP WSPECTIoH SVBY DATE I / FINAL .RBY DATE/Z 1 A6 17 <br /> ADORIONALCOMK%WTS: <br /> JZ^16-II IwWRE3*N�A'ED LT�7.♦, OA7 O'C <br /> ACCO VNTRq ONLY: ADI - FAC/ <br /> R CODE <br /> FIEINFO,j AMOUNT REM(ITED HEL ;CASH RECR3VED BY DATE Ill PEVAT NIAIBER INVOICE <br /> �z <br /> I/ <br /> Pub.Heeryh SeN.-Erwo.174(3186) <br /> t <br />