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APPLICATION FOR LIOUIO WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION J 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)4683420 W999EFUMDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (� {C.EyMt.I.Tfkk%gt.1 APPIJCATON 1.HEREBY MADE TO THE SAN JOACUM COUNTY FOR A PERMIT TO CONSTROCT ANOrOP INSTALL THE WOR(DESCRIBED. TME APRJLAT ION IS MAGE IN CDLEl3AMC'E WNTN EAN "ROUTH COUNTY DEVELOPMENT TITLE.CHAPTER 0-1110.3 AND TIE STANDAIOS OF SAN JOAOLRN COUNTY PUBLIC HEALTH SEANCES,EN%MNCw RNTAL HEALTH DNRION. JOB ADORESBKIA APR# 7 �- 17-- jhl,r Y Gai n11 L4 CITY L ,1 E^OTT SIZE L! C1 R'S NAME _SL�c- G ADORE!! S�•,on c— PHONES/zL f ^D 7 On CONTRACTOR_ � 1 I<c- I-LSE II tr ADDRESS IP O -4 r)11 SCS Fn CPA1`!4/4 UC# nk�PIMNE BIR COMPACTOR AGGRESS_ XS-53o LAI %`MHS TYPE OF SEPTIC WORK: NEW IMSTAUATION PIFANUADMTION❑ DESTRUCTION❑ IND SEPTIC BYSTETA PERMITTED W PJSUC SEWER IE AVAILABLE WITHIN 2ND FEET OF BUIDIND-I F7/IC 7SSTH1 11WJW MANY -�/ ARSASSI,n P LNSTALLATION WILL SERVE: RESIDEN^.E Ij/ COMMEPCIAL❑ 13OTIIEP NW.9U DF LlNNG UNTS:_ _�_NUkMM OP BEDROOM.. 3 NLSABOL Of RI/IDYEDE: CHARACTER OF SONL TO A DEPTH OF 3 FFEET: E.I. �/0�1 RT/BUMP SOB EI CHARACTEWATER TABLE DEPT SEP TC TANNAIRSASE TRA1 Tr P y .IFO 7-L CAPACRY 1;1I --�C] No.COMPAMwFNT� PILO TREATMENT PUNT❑ DISTANCE TO IIVILMST: WELL I CS n I FOUNDATION IJI RIDPEPTY LINE �S r UPT STATION O l 1- LENGTH TYPE OF PUMP IDL MP SAOSEPARATOR ENCLOSED SYSTEM) _ LEACHING UNE ID NO.L OF LINES_ LA.'S 1 dBTANCE 7O NEAEEET:WELL I C)5 1 MU DA71ON 10 PROPERTY LINE I;b I FILTER BED ❑WIDTH LENDTN_ DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPER"LINE MOUNDED ❑WIOTN LENGTH DEPTH DISTANCE TO NEAREST:WELL FDUNDATION PROPERTY LME SmAOE PITS 0-DEPH 15I am 34.t{ NUKWR_ DISTANCETONEAREST:WRL EtiDUWATIDN��FPDPEPTYUNE L,v BWPS ❑WIDTH 4 LENGTHDEPTH DISTANCE TO HEAREST:WELL _FOUNDATION PROPERY LM 05POSAL FONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEMEST:WELL FOUNDATION PROPERTY UNE 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE YAH%WEA BE DONE N ACCORDANCE WITH JAN JOAGUN COUNTY OPDP/ALCES AND STATE LAWS,AND IMLES AND REOULATTORS OF THE SAN JOADIAN COUNTY.NOME OWNER ORL1CYNSED AGENT'S SIGNATURE CE1RIR!4 THE POLLOYINO:'1CIDDIFYTHATW THXPIDI S#ANCE OF THE WORK PORWHICH THIS PELWT IS ISSk",1 SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME VjWECT TO WORKMAN.'S COMPENSATION LAWS OF CAUIORSA' CO CTOII'B I.RNG OR ME-CONTRACTING SpNATUPE CERTIFIES THE FOLLOWING'7 CERTIFY MMT IN THE PE7EORAANCE OF THE WORK FON WHICH THIS PUNT N ISSUED.1 SNAIL FIAPL.DY I EEISONB SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.• THE APHIO/WT MUG'CALL 24 HOURS IN ADVANCE FOR ALL IEEOUNNED^I/YPFLTONS.COMPLETE DRAWING KLDW. SIGHED% (/(/ V � TRLi:_ Cool�1 �L��C� DATE: 0 PLOT PLAN SHAW TO SCALE!SCALE_ to 1.NAMES OF KARTS OR ROADS NEAREST TO OR BOLMDHO THE PIOPERTY. 4.LOCATION OF"DUN SEWADE OYKISAL SYSTEM ON PRI POSED 2.OUTLINE OF THE PROPERTY.ERTY.WITH CSAEHIIDNS ANO NORITH DIRECTION. EXPANSION OF BEWAOE TKSPOBA SYSTEMS. J. DIMENSIONED OURINES AND LOCATION OF ALL E%ISTWO AND PROPOSED STIIUCTUIES, S.LOCATION OF WELLS WITHIN RADIUS OF ONE 14UNOFWD FIFTY P.ON INCLUDING COVERED MUCH AS PATIOS DRIVEWAYS,AMO WALXS. THE PIDPERIY OR AD.AMA PROPEIM 1!_—'d `�� - f�.. .. N A3 so ... .. 3�, Kz3 ..- 1' S G-- — — — 1 p4.S�I ..:... .... . ... .... .. ..... :. ... ............ .... . _:. ... .. i/1 —(JCS NG- .. s<V L>t�;•.P.�' 1 .. ... .. ... ... '. ... s,ILA i- 1A�I (//�S�' AP 71NE MLY / C> APPLICATION ACCE9f ED SY t,/� L DATE: • TAM.TT OR—P MSMCTIOII BY DATE I I FINAL WSPEC'TION BY / � DATL I r I (�U ADDITIONAL Accovnnwa oNLr� AAJ PACA �I7' F FEENF'O AMOUNT PDM)IT— CLECK/ ASH RECEVm ET D NPA.Q4 INVOICE0 II L Zjd2A� Pub.Hselth Sery -Em m.174(396)