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APPLICATION FOR LIQUID WASTE PERMIT f 3 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468-3420 NON•REFUIIOARUE PURN9 EXPIRES 1 YEAR FROM DATE ISSUED (C6np16IS IR TrIp8A6u) APPLICATION IB HEREBY MADE TO THE BAN JOAGUIN COUNTY FOR A PEMUT TO CONSTHUCT ANWOR INSTALL THE WORK DESCRIBED.THIS APPLICATION 16 MADE IN COMPUANCE 1M 14 SAN JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER 6-11111THEj0.3 AND THE STANDARDS OF SAM JOAOIAN COUNT'PUBLIC HEALTH SERVICES.ENVEMMUENTAL HEALTH IM4610N. JOB ADDREOBAOR APNF // T- R.-2 /r5 G J�/S'/Sr CITY G LO^T�SVF OWNU1'R NAME ANi.7/C��/ /R.-2 •-e L 6 ADORE58 1PHONE NTR COACTOR /Q, ADORE90 ;•� PMNE�1� SUB CONTRACTOR ADDRESS LIC• PHONE TYPE OF 6EPTIC WORK: NEW INSTALLATION Iy REPAWADDITION ❑ DESTRUCTION❑ NO SEPTIC SYSTEM PERMITTED IF PUSUC SEWER IS AVAILABLE WITHIN 20O FEET OF SUMAHO.1 PEIC TESTMO{$NOW MANY � IAp,4—d—F INSTALLATION WILL SENSE: RESIDENCE 171 COMMERCIAL 74 OTHER❑ NU6ISUR OF UPANO UMT4: NUMSM OF BEDROOMS:/ NUABM OF @NFLOYFEA. CNIARALTFR OF SOR TO A DEPTH OF 3 EEET: /PrTtsLW SOIL CHACTER: WATER TABLE DEPTH -22: SEPTIC TANKOGREASEM TP ElPE:M TYFO� RA A^�� I/-„ CAPACITY /llfl�YJ _ NO.COMPARTMENTS V PKO TREATMENT RAW 11 DISTANCE TO NEARST %" FOUNDATION FOUNDATION 4� PROPERLY UNE LIFT STATION❑ BRE TYPE OF PUMP SAND OIL SEPAAATOR(ENCLOSED SYOTEM) LEACHING LINE ❑ NO.A LENGTH S OF LINES INOTANCE TO NFAREST'WELL FOUNDATION PRR OERTY UNE FILTER BED M WIDTH--P-�I LENOTH�DEPTH —5 DISTANCE TO NEAREST:WE11 FOUNOA710N��MWPERTY LINE MOUNDED ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE SEEPAGE FRS ❑DEPTH SITE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PRDPERTY LINE &USPS ❑YVIOTN LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE DISPOSAL POND■ ❑WIDTH LENGTH DEPT1r OIIRANCE TO NEAREST:WELL FOUNOAT1ON P"OPERTY LINE O I HEREBY CEMP YTHAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORT WAIL BE DONE IN ACCORDANCE WITH BIW JOAOUIN COUNTY ORDINANCES AND 9TATF LAWS,AND RULES ANDREGULATOHS W TNESAHJOADIIN COUNTY.HOMEOY4HER0IRUCAN%D A0ERT'6 BKiP1ATUFE CERTIFIES TTIEFDUOMAq:'ICERRFYTHAT 144THEPU601MAAHCE OFTHE WORK FaRWHW-H 1 THIS PFR.TT R ISSUED,1 MALL NOT EAFLOY ANY PERSON M SUCH A MANNER AS TO MCOEIF 6LRGIECT TO VARKMA ITS COMPENSATION LAWS OF CALiIWINIA.- CONTRACTOR'S HIRING OR SVS-CONTRACTING SIGNATURE CERTTPIEB THE FOLLO WTNG7'I CERTIFY THAT N THE PERFORMANCE OF THE WOR(FOR MOCH THIS PERMIT IS ISSUED-1 SHALL EMPLOY PERSONS SUBJECT TO WOR:MM'6 COMPENSATION LAWS OF CALIFORNIA-' INE AlRNCANT MOOT CALL 24 MOCKS IN ADVANCE FOR ALL REOUEIED INSPECTIONS. COMPLETE DRAWING BELOW. SIGNED K TOLE DATE: i PLOT PUN RMAW TO OCALEI SCALE • -� 1. NAMES OF STREETS OR ROADS NEAREST TO 011 ROV14DWO THE PROPERTY- IA4.LOCATION OF HOUSE WWAOE DOWDSAL SYSTEM OR PROPOSED 2. OV TUNE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSPDN OF SEWAGE DISPOSAL SYSTEMS. •h 3. DIAENMWD OUTLINES AND LOCATION OF ALL EMITTING AND PROPOSED BTTUCTURES, 6.LOCATION OF WELLSOFIS WITHIN RAOF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AEN WALKS. THE PROPERTY OR ADJOINING PROPERTY. ..,......' .:... ... ... .. ... ................i ... .. . ... ,.. ... i..T... .. ... - < ..... .. .:.... ;... .i. ...... ...... .. .... i ......................... .... ..... // .. ..... ..... ............. ......_ {r! f- f i ......:..... .... .. .... . ............:..... . '... .............. �' NT �g ..... .. ................:.....,.. _:....... ..: ..... : :... . ....... ...;... .JUN 2 91998 4........................: .. .. ..... . ' SAN JOAQUIN CGUiJ'fY V.U@I,IG HEALTH SEFNIG��„- ENVIRONMENTAL HEALTH DIVl5lE7ly � .. ... .... .......... ..._ -. .. ............. `.,... . . t ........... �, ^ FOR DEPAFT/AENT USE ONLY APPLICATION ACCEPTED BY -f�}'] f�A ['T =mnl /Yl'�/�A^-�� DATE: AREA: TAW,PR LI OR BMP INSPECTION BY (n - DATE I ! FINAL INSPECTION BY •+-- _ DATE I A I r 1 ADDITIONAL COMMENTS: ACCOLRSTINO ONLY: MIDI FAC IF PE IN CODE FEE FO AMGIIRT PIANS ITED CIIEC ASH RIPCENED BY DATE OII J 1NRR1T ryLE1EB61 INVWCE F Pub,Health SeN.-ErrvirG.174(3196)