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APPLICATION FOR LIQUID WASTE PERMIT Y <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES VVV��A <br /> ENVIRONMENTAL HEALTH DIVISION �V <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 �n <br /> ROIL REFU40APIE PERNR EXPIIIES 1 YEAR FRDM DATE ISSUED ` <br /> 106SpiEb in Tri'Ratq <br /> IT <br /> APPLICATION 18 HERMY MADE TO THE SAN JOAQUIN COUNTY FOR A PErT TO CONSTRUCT ANG"INSTALL THE WOW DESIN DESCRIBED.TO08 APPLICATION 18 MADECOMPUANGE WAPPLICATIONIAIH SAN <br /> JOAOUSN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.7 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SENICES. ,~RMENTAL NEALTN DIVISION. <br /> C(.n, LOT 812E <br /> JOB ADORESBKR APR/ CJ `/f <br /> CNM M'E NAME <br /> AOORESH �,,�0 J <br /> CONTRACTOR <br /> ADDRESS UCS PINDNE <br /> ELLS CDi7TRACTOR <br /> ADDRESS UCF PIONS <br /> TYPE OF S4"C WORK: NEW INSTALLATION REPA1RADDITIOPr ❑ OEITRUCTION D <br /> RBRG 7FSTb1 I I MOM MI1NY <br /> ,NO SEPTIC SYSTEM PlTOlfTTED F PUBLIC b2WER I8 AYASA9lE WN 200 FEET OF BUILLWNO.I <br /> � <br /> // ASPPoStloN S <br /> INSTALLATION WILL SBrYE: RESIDENCE❑ COMMDCIAL❑ OTHER lJ <br /> WADI R OF UNND tftw RASSETR OF SSDROOMS: N—drOF PA LOYSEI; <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: -,PIITISUMMP,ML CHARACTEIC WATER TANS DEPT <br /> SEfnC TANK/01E'ILSE TRAP TYPEIFAF<f C1 ` CAP I 6 NO.CdJPARTMIHTS <br /> we TIREATMElT RANT 13 DISTANCE TO NEARDT. YIELD~ � W7OAT)ON—l0/ PROPERTY UNF-L <br /> LRT STATION❑�pSQT TYPE OF PuMp �) SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACHING WEE yv NO.S LENGTH OF LINES�+ ./_� dE <br /> STANCTO NEAREST:WELL FOUNDATION �1)! PROPERTY LR4�6 <br /> /` LENGTH pEPfN OIeTANCF TO NEA1E87;WELL_ <br /> FOUNDATION ��T.UNE <br /> FILTER SID ❑WIDTH <br /> MOUNDm ❑WIDTH LENGTH DflRH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LDIE <br /> EgDAOi FIT( ❑DEPTTI <br /> EWE NUMBER DISTANCE TO NEAREST:WELLFODUNOATION PROPERTY UNE <br /> SUMPS ❑LVTDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL FONDS ❑WROTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HERESY CERTIFY THAT I HAVE PREYA/EO TMM APPUCATION AND THAT THE WOW.WILL BE GONE IN ACCORDANCE WITH SAN JOAOUM COUNTY OROSUNCES AND STATE LAWS.AND RLAFB 1 <br /> AHDNEOULATIONS OF THE SANJOAOVM COUNTY.HOME OVMERORLICENSED AGENT'S SIGNATURE CWTNNN <br /> N!STHE FOLLOWO: <br /> MN ER 'ICEIfE7FYTNATINT11E1'[IfOMAANO�E OF TORE NpONO OR <br /> THIS PERhw IB ISSUED.1 SHALL NOT E pLDY ANY FERSON MUCH A MANNAS TO 1/E✓r� JE <br /> SUBCT TO WORKMAN'S RNI <br /> COMPENSATION LAWS Of CALSO <br /> S PERMIT IS ISSUED,I <br /> +NOIBCMAIITU COMPENSATION UwS�F�CAU FOLLOWING:-rCDRTWY THAT IN THE PERFORMANCE Of THE WOW FOR WHICH ADF'UOART MUST CALL M HOURS M ADYJWCE FOR ALL RECUMM H(RS/EC.-RS DRAW GG pELpW. S1pJECT 70 <br /> TRUE: __GATE: <br /> SIGNED X <br /> PLOT PLAN DRAW TO SCALD SCALE 'to <br /> ♦.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> L.NAMED Of BTREETD OR IIOADS NEAREST TO OR 60VNIDRNG TK PROPERTY. EXPANSION OF SEWAOE DISPOSAL SYSTEMS. <br /> E.OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. I S AT10N OF Wf11A WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> ,.DIMENSIONOU AND LOCATION OF All EXISTING AND PPO6ED STRUCTURES. ! PffrTY OR AO•IODNNNG pIOPERTY. <br /> BOON AS PATXM DRIVEWAY&AND WALLS. <br /> .. ._. <br /> ...... .t .. .. ..... .. :.... ... $. <br /> �ozz -�.rb .. <br /> a <br /> L <br /> � ... <br /> .... ................... :....:.. <br /> ::::: <br /> �-T� <br /> ...::...:.:::...:....... <br /> IN <br /> y, E�, 14ke <br /> p <br /> .. ................:...... <br /> .... <br /> .. <br /> ............. <br /> E'ViS.C.H AILTHSEFlVr465 <br /> FN� ENfENfALHEALTHDIYlSIf:. ....... - - <br /> OEy VEE ONLY <br /> N DATE: L —A!"� <br /> APPLICATION ACCE�S�y +O/ <br /> TAM.PIT OR BUMP MSpECT10N BY <br /> DATE l I FN.LL INSP'E TE /d <br /> ADO(TIONAL COM MENT6: <br /> ACCOUNTING ONLY: ADI FACS <br /> FECGOE FIIINFO AMOUwTRemITm OIIEC%/ REC By DA E NU.1SSIR INVON:SI <br /> 2 t a.00 011954 <br /> Pub.Health So--EnYIrD.174(3/96) rr /" ({x�j' -J�� a��p/�nJ�� �����• V/�"W <br /> p=fi�r 6-L'` co� <br />