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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 381,445 N.SAN JOAQUIN ST,STOCKTON.CA 95201�(1181 <br /> {209)461-3420 <br /> NON-REFUNDA/LF PERMfT EXPIRES i YEAR FROM DATE ISSUED <br /> 1Ca.pIM im Trogate) <br /> APPLICATION M M V BY MADE TO THE SAN JOAWN COUNTY FOR A PFF"T TO CONSTRUCT AADVA INSTALL THE WORK DESCRIBED. TWO APPIKATION b MADE N COMFLWCE WREN SAN <br /> JOAOUN COUNTY OI'VELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOUN COUNTY P USUC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. <br /> JOSADORESGgRAPNP 5950 E. Woodbridge Rd. crrY Acampo -,Tsnacres + <br /> OWTEWSNAME R.M.E. Inc. ADOPF[B same: PHONET�/A <br /> cONTRAcroR Morton Septic ADDAF99121 E. Churchill ST. StkL,, 444225 PAONE 463-5343 <br /> SITS CONTRACTOR ADDRESS UC r _PHONE <br /> TSPS OF @arm WOR[. M?MI IIISTNLATION 10 REPAPIJAOORION❑ LMFSTRUOTION❑ <br /> IND SrPTIC SYSTEM F[AMRTEn IF rum SEWER 10 AVARMLE 110 M ZOO FEET OF"LDV-, Flow TLTW 1 I NOM/MAMY <br /> ,y AIRYaSSm� <br /> INSTALLATION WILL$WVE: RESIDENCE G COMMERCIAL 13 OTHER❑ <br /> NLIH.Y1 DF R,YrRG UNITS: IVUAreI CP SSDRppOORES: NMIiie1 of SMRAYIA:_-,�TC'74pj <br /> CMMACTER OF igIL TO A DEPTH OFrT��3 FEET: S a n 4 PTTISUMP SOIL CHARACTER:s d TlC�1 loam <br /> WATER T .DEPTH —�— <br /> SEPTIC TANVORIASETRAP IOTVPEAE,. concrete/ P&L CAPACITY 16600 gal NO.coMPrxrwExri <br /> PKG TREATMERT PUNT❑ OMTANC[TO IRIARR[ST: WELL FOUNDATION 3 2' PROPw..rY LIE <br /> LF7 STATION CHU ❑,yBIZE TYPE OF PUMP $AND OIL SEPARATOR ENCLOSED SYSTEMI (�h <br /> LEANO NE Eft NO.S UENOTH GP UNES�93' 1ines DRSIANCE TO NEAREST:WELL PROPERTY R <br /> FOU A71ON 2 0 1 PPERTY LE `-'lL <br /> FILTER IED ❑MuTN LENGTH_ DEPTH OWTO NEAREST:WELL F-AWDATgN PROPERTY UNE <br /> MOUNDED ❑MUTH LENGTH 'OEPTH DISTANCE TO NEAREST:WELL FOINDAT)OP1 PROPERTY UNE <br /> SBVAGS PRS X]DE➢TH 2 5' SIZE 4 2" .NUMSER3_DISTANCE TO NEAREST:V ni _FOUNMTION 2 O' PROPERTY UNE <br /> EDIUPF D WIDTH, LENOTH :IEPTIR DISTANCE TO NEAREST:WFIXI _FOUIOATTO/I PROPERTY UNE <br /> DISPOSAL PONDS ❑WIDTH LFNGTH DEQrN DISTANCE TO NEAREST:WELL,_FOUNDATION PROPERTY LRE <br /> I HERESY CERTIFY THAT I HAVE PREPNRED THS APPLICATION ARO THAT THP WORK WILL BE DONE N ACCORDANCE WT(N SAN JOAOUIN COUNTY OIOSUANCER ARD STATE LAWS.AND RULE! <br /> ANO REGULATIONS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LICENSEE,AGENT'S SIGNATU RE CERTIFES THE FOILOWING:'I CERTIFY THAT N THE PEIFOFMAINCE OF THE WOM FORMWICN <br /> THIS P[1MGr IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON N SUCH A MANNER AS TO BECOME SUBJECT TO WOWMAH-9 COMPENSATION LAMS OF CAURORWA.' CONTRACTOR'S HIRING OR <br /> SUBCONTRACTING"NATURE CERTIFIES THE FOLLOWING '1 ERTIFY THAT IN THE PEPFORMAIICE Of THE WOFK.FOR WHCH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TD <br /> WOR(MAN'E SATgN LAWS FOMIA.' TH[ AMT MWT CAV M HOURS N ADVANCE PORI ALL RBOLMAND SNPS711 m-COMPLETE DFIAWM BELOW. f'^+ <br /> STONED TULF: cont ract.Qr DATE: 11-14-94 <br /> PLOT PLAN DRAW TO SCALER SCA+E 'to (V� <br /> 1. NAMES OF FIRMS OR ROADS NEAREST TO OR DOUNOWG THE PROPERTY. 4.LOCATION OF NOUN SEWAGE DISPOSAL SYSTEM OR PROPOSED V('(• <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSONS TWO NORTH DIRECTION. EXPNIBION OF SEWAGE DISPOSAL SYSTEMS. 1 1 <br /> 7. OR.ENMONLD OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES. [.LOCATION OF WELLS WITHIN RADIUS OF ONE WROD ED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIO/,DRIVEWAYS.AND WALKS. ... THE PROPERTY OR AD.IOINM PROPERTY. <br /> ..... <br /> PAYMEw. .. <br /> r .R <br /> ECOVED <br /> . . .._ . . __ ..... . . . AW 14 1904 , <br /> AM I <br /> SAN'JOAQUIN COLINTRf <br /> HEAITTH 4ER++'I£f.A <br /> NdVIRQN NTALHEALTA D1VF31 <br /> POR DOARYmeFT USE ONLY _ <br /> 19 APPLICATIONACCEPRT BY C OAR: <br /> SApPA rtT OR 6UI,F SNSP£CTION SY DATE_f f.,�,� NAL INWECT..BY <br /> ALIO IIT)ONK COMMENTS: L T <br /> ACCO VRIMO ONLY: AIDE FACA �Fp1 <br /> P[CODE FEE INFO AMOUNT R9IUTTED /CASH RECEIVED BY DATE M I PeNST NLSABM IFVOI[E 0 <br />