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i I SQUID WASTE PERMIT QVIN COUNTY PUBLIC HEALTH SERVICES `"'��NN 1 �L � IRONMATAL HEALTH, VISION �0.1'a , SANii tae *,Tl�l:lit_ i, O�Q$ SAN JOAOUIN ST,STON,CA 96201-* hI.NFA1� �I CDG �i (209)488.3428 �L� 1 A r 1�I }•, r� JS NDN*RfFUNBABLE PERMIT EXPIRES I YEAR FROM GATE ISSUER ICI (;•y a BPI$M i6 7,01i ati) �1J ' PUCATgV IS HEREBY MADE TO THE SAN JOAOUN COUNTY FOR A PERMIT TO CONST RUCT AND/OR WSTALL THE WOW DEBCFDBED.THIS APPLICATION 16 MADE NI COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-111 0.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICE8,ENVIMI—ENTAL HEALTH DIVMGN. JDB ADORERS."APR# D\ F 5-() .5-6- TYf4C�/ Gj L.l/Cf. cNY Tylyr-Y LOT SIZE OWNER'S NAME AN,'G/T' SA LLAT L= ADDRESS PHONE CONTRACTOR�t(17 c d�* 54r N ADDRESS SUBCONTRACTOR ADDRESe LIC• W.ONE TYPE OF SEPTIC WOW NEW INSTALLAMN❑ REPAWADDRION W RESTRICTION❑ IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IB AVAILABLE WITHIN 200 FEET OF BW LDMIO.) PSRC TYThI 1 1 MO`N MANY Ap/IaM1an/, IN67ALLATION WILL SOW[ RESIDENCE;a COMMERCIAL❑ OTHER❑ NURSER OF LIVING UNIT*:/NUMBIt OF BIDNOOM6: W M M OF WAKoyEU: CHARACTFA OF SOIL TO A DEPTH OF�3 FEET: 4et.1M PR/BIJLP BOR.CHMACTER:SANd-6�/f WATER TABLE DEPTH- "-_ rEPTIC TAN%/IREA$E TRAP IJTYPE/`AFC OYP CA S I CAPACITY / J.GT b _NO.COMPARTMzwo MCO TREATMENT PLANT❑ DISTANCE TO NEAREST' WELL 3 n FOUNDATION X0 IYIOPERTV L:.E -S O UFT STATION❑ WE —FE OF PUMP SANG OIL SEPARATOR ENGLOBED SYSTEM) _ LFACHNO LINE ❑ NO.B LENGTH OF LINES DISTANCE TO NEATEST:WELLFOUNDATION FvcwERTY LINE FILTER BED ❑WIDTH LENGTFDEPTH DISTANCE TO NEAEST:WELLFOUNDATION PROPERTY LINE MOUNDED E]WROTH LLNGTH_ DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE SEEPAGE RTS FSN❑�DEPTH SIZE —NUMBER UNIT ANCE TO NEAREST:WELL —DATION PROPERTY LINE SUM" ctWY1O1H s-i LENGTH �7� DEPTH V" pb'TANCE TO NEAREST:WELL �y FOUNDATION /jnT PROPERTY UNE /f� DISPOSAL POND$ ❑WIDTH LENGTH-DEPTH DIBTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE 1 HLREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WMI L BE DONE IN ACCORDANCE WITH SAN JOAOUN COUNTY ORDINANCES AIB]STATE LAWS.AND IDLES AND REGULATIONS OF T HE SAN JOAOUN COUNTY.NOME OWNER OR U�ENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWM !'I CERTWYTHAT N THE PEPFOFOAANCE OF THE WORK FOR WHICH )IIT/1J THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WOWCMAN'J COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIIWO OR ` SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WOML FOR WHICH THIS PERMIT IS ISSUED.I$HALL EMPLOY PERBONS SUBJECT TO WOWLMAN'S COMPENSATION LAWS Of CALIFORNIA.' THE APPLICANT Mu$T CALL N MOUES IN ADVANCE FOR ALL REONIIED INSP'ECTIONB.COMPLETE DRAWING BELOW. p SIGNED% !C! TITLE:_ DATE: �/ \ v ROT RAN IDRAW TO SCALE)SCALE -to _ 1.NAMES OF STREETS OR ROADS NEAREST TD OR BOUNDING THE PROPERTY, A.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 3.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. "PANSION OF SEWAGE DISPOSAL SYSTEM8. \ 0.DIMENSIONED OUTUNES AND LOCATION OF ALL EXISTING ANO PROPOSED STPUCTUPEB• 6,LOCATION OF WELLS WNTHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS.DRVEWAYB•AND WALILB. THE PROPERTY OR AOJOMAIO PROPERTY. . ...... ............... .. .. :... . . .5Ao� Io :... ;...... ... �.. G :.. ....... r ra .........................� L3T. �1GaEE� 45�, •s .u> .......... 4 APR `. :l.... '....... IT ...... . . ....... ...... . = . -'31'B LIC NEAT•1:��VIl,F•.. -. 1w =r»fIRONMENih'L HEM TN'P ti 151; FOR DEPAATMSNT URE ONLY APPLICATION ACCEPTED BY Ate_DATE: - AREA: _ TANG,PT OR SUMP INS'ECTION BY DATE f FNAL INSPECTION BY DATE , ADDITIONAL COMMENTS: c5ze.KLQ , ACCOUNTING ONLV: AIM FACY /2 PE COJE F1-4� AMOUNT REANTTFD CLEC ASN RECEIVED BY DATE 18L I PERMIT NUMB61 INVOICE/y0 -l1 I ✓�`MVV V