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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,904 EAST WEBER AVENUE,STOCKTON,CA 55201388 <br /> (2091,488.3420 <br /> 111OM-REFU110ABLE PERMIT EXPIRES 1 YEAS FROM DATE ISSUEp <br /> {Gapkr&In TAPIkat&) <br /> n.;q Ir Al I-IN;A UFRFRY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TD CONSTRUCT ANDIOR INSTALL THE WOW DESCRIBED.TMS APPUCATFON IS MAGE IN COMM I+Nr" '•N <br /> J'I.AWIN COUNTY UEVELO[PMFN (TTITUEE�.CHAPTER 9-1110.9 AND THE STANDARDS OF <br /> SANNnJOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRDNL49MAL HEALTH DIVIS'T:N <br /> ."N: 71111 1.C1 .. '--�AtAc <br /> .f.i•,r:i.IF ./ '�����—K.. /��t•�t��-ADDRER3__. I{�'��j/, 1� � (�y.�/_FHiiNEp�J.-rJ��),�/.. <br /> ... (C� ADDRFSB[�// 3L-��"� - T IKR�?GIJ RtONF �"J �7Y� <br /> • -•••.rr•T.0 XAr ,�•�NEW INSTALLATION❑ REPAMIADOITION DESTRUCT40N❑ <br /> a•: •"rt 5'-6T rLI rR.RMUTED IF PUBLIC SEWER 43 AVAILABLE NATHIN 700 FEET OF BUII.fama I PBRC TFtihi(1 NOW MANT <br /> Ir,..: .•ti.l t•AV8 4ESIr ENCE L! COMMERCIALI(S OTHER LI___ .._. •-- —. <br /> .• ....^•;1:••�•'IRIt. NVMSER OFB EDROOMS: MVWSER OF EAPI.DYEES: <br /> • •1,.•i •.1 A 'T'i H Of�-1FFFT' ir•[ NT/SUMP 3011 i.HARA,,TFA a�'I�- WATfR TABIE OFFTIi __ __ <br /> ., ... .e ... <br /> -m. L3 TVTVAAr O— _C:APM:I'1'I ^. NO,LGMPARf MLNi S <br /> V -,DAVM MAN'Q DIGTANCE TO ITTAREA77 \VEIL FOUNDATION PROr•ERTY NINE_.—_- <br /> L1FT STATION❑ SIZE TYPE OF PUMP BAND OIL SEPAPATOR]ENCLOSED SYSTEM] <br /> LEAC,NNO UNE ❑ NO.S LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> FILTER BED ❑MDTN LENG114 DEPTH DICTANCE TO NEAREST:WELL _FnVWATION PROPFJrT1'UNE-,_,-- <br /> MOUNDED ���/// <br /> Q...vAmN LENOTN _DEPTH DISTANCE TO NEAREST:WELLy,,' FOUNDATION PROPERTY LWE_ _ __Al'�1 <br /> SEEPAGE PIT& j�DEPTH WE�C+♦ NUMSER_�DISTAHCf TONEAREST:WELt,? ,� ��PERTY 1_--— <br /> FOUNDATION <br /> SUMPS ¢TWIUTH�^ LENGTH (On• DEPTH{Q• DISTANCE TO NEAREST:WELL ' FOUNDATION/4 I PROPERrY LINE <br /> nrSPOtAI PONOS ❑WIDTN LENGTH DEPTH DISTANCE TO IJEAPEST:WELL FOUNDATION FROPERry LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOFK MILL BE DONE Si ACCORDANCE'ORTN BAN JOAQUIN COUNTY DIOSIANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE CAN JOAQUIN COUNTY.HOME OWNER ORLICENSED A4ENT8 SIONATUIIE CFJTTIFIFJ E WTEWWFORWUCHANCCQF <br /> THIS PERMT 1E ISSUED,I SHALL NOT EMPLOY N IN SUCH A MANAS TO BECOME SMJECT TO WOW.MAN'S COMPENSATION LAWS OF CMJFOPlIIA.• COMPACTOR'S HINNO ON <br /> SUSCONTTNCTIN ATUIIE CEPTf1E8 TftE PoLL NO:'L YT' W PEPIFORMANCE OP TN[WOISC TOR W111C1i T18/PEIWT IS iSaITED.I INFILL E,MIOY PERSONS SUBJECT 70 <br /> WOWMAH'8 MPEPIS IO OF MCRNIA. TME APMICANT T C N/RDW IN ADVANCE PD/R/A��LL KOtatm INSPIC/T/EOMS, CI)NiLETE OIRAWINO BELOW. <br /> `._.. ` r- PI.Gr PIAN(DRAW TO SC ALE]S(:A:F�"-_.__•io <br /> I •.+ I`I Sl Ill�.1.�:IN 110AOS NEAREST TO OR 8OUHCING THF PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM f-N :. <br /> f '•:I^IF fIY <br /> ­t PM)NFRr,.WON 01MENSIONA AND NORTH DIRF.CTION. EXPANSION OF SEWA3E DISPOSAL SYSTEMS. <br /> I 'H'1:61I1NEIi OJI1.INIS'fin LOCATION OF ALL EX46TING ANO PROP'OREn RTNIICTUPE6, 6.LOCATION OF WELLS WTMN RADIUS OF ONF HUNNY71 <br /> INC LUDINO COVERED AHEAK SUCH AS PATIOS.ONVFWAYS,AND WALAB. THE PROPERTY OR ADJORMG PIIOPEm _ 1 <br /> it <br /> .�n, V <br /> q' <br /> / teaJe uric . .rr 3b.,XzS" F7:+S <br /> j �t 'vim _.. . ..' .: 4,r E.,L�?• .3.�:+,>r... .. . . ... . .. ... . <br /> FOR DEPARTMENT UE ONLY <br /> ��i'''''III <br /> APr•1;CATION ACCETTEO BY 1 J DATE: AREA�- 2 r <br /> t'ANK,FtT OR 5 MP I�NF/FETID DATE / I FINAL WSPECTION BY GATE I 'l,fp <br /> 11Vi11FAyy�{F:Gc 1• ♦ i♦l / <br /> noolnoNAL crtAMFNT6:pZ- ♦fS Z S to Rr CPC• •7t¢ "" 1 , <br /> ,UV� S E n r f I Nt J sa l d, <br /> A"^•:l1N TING ONLY: ANO/ FACE F(Ft <br /> IE CODE FEE INFO AMOUNT RDNITTED CNECKf A&N REC DVEO&V DATE fA I pflSLIIT Nummit INVOICE F 1 <br /> t4f;----- - <br />