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APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 6 ENVIRONMENTAL HEALTH DIVISION ��3 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)4SS-3420 ROI4R4f111141S1E pEAWT WARS 5 YEAO MIA 13111 ISSDFD rwax0sn IB Tr0FEW APPLICATION M HERESY MADE TO THE SAN 10ACUIN COUNTY FOR A PERMIT TO CONSTNlCT ANDOR INSTALL THE WORK DESCRIBED-THM APPLICATIONN MAGE N COMPLIANCE WITH SAN JOADIAN COLNTIY DEVELOFMFNr TTfta-CHAPTER 9-1110.3 AND/THE STANDARDSOF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,FIPVRIOISAENTAL NEAL"OMWON. 1.ADDRFsaroR e-a 1 1 S7// Cm flGu^j�p zLOTymsE C�Aj f I OWHDITi NAME 1C__7 L•�Yl 1`�(�._�'«�•/ _ADDRE58 —PHONE..Z J-I'2 �v eowrnAcroR��lu�l- S'�C� ��c—.�ADOREsss21 �.C hL� uL! uS PNDNE (o 'f WS CONTRACTOR ADM $9 LICE PHONE TYPE OF Sorin WON' NEW 1NS1ALLATIOM❑ NETAWAepTiOX DUTRIICNON❑ ANO SEPTIC SYSTOA SA POTTTED F PUOUC SEWER IS AVAILABLE WH1SN 200 FEET OF SU NO.I PSC TUTW I 1 NOW MANY APPSwSPA l INSTALLATION WILL SammFESIOENCE�c COMMERCIAL❑ owE7R B IIN/ "Mom OF LO UNITS; / NUMkM OF BEDROOMS: NUIDrFI OF EMPLO�YE�ES:,� CHARACTER OF SOS TO A 00"OF G!'EY � � PRiSU1M BOM1 CIIARA,C'TETI.�y_[!.O`��WATER TABLE OlPT 4.�-- S1PnC TANRIOREASE TRA-•PElTYPEMFiI CAPACITY �� ND.COIMPARTJEMB PLO TREATMl1LT PLAN-�T 0 DISTANCE TO MEARWT: WELL FOUNDATION PROPERTY UNE UFT STATION[I am TYPE OF PUMP SAND OE SEPARATOR IENCLOBED BY67ENA{ LEACHING UNE �NO.SLENGTHOFLNEB/'-yP*;Z;t•�-/f• DISTANCEREF TONEAT:NIELLCn I FOLLNDATION /01 PROPERTY IJNE�_ FRTM BED ❑WSJTT/ LENGTH OEM DISTANCE TO NEAREST:WEU FOUNDATION PROPERTY UNE MOISIO® D WIDTH LENGTHHDEPTH DISTANCE TO NEM1EM WELL FOUNDATION PROPERTY UWE SEEPAGE PITS 'DEPTH SIZE-a&I'_MIMBET__l _DISTANCE TO NEAREST:WELLL.�MUNDATION /0' PROPERTY UNF S r SWAPS ❑WCTH LENGTH DEPTH DISTANCE TO NEAREST:WFJ.L FOUNDATION PROPERTY UW — DISPOSAL PONOS ❑VIHTTN LENQiH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPEF(Y LINE 1 HrPESY CERTIFY THAT I PUVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE MATH SAX JOAW N LOAIHII.HIE ERFORN ANO STATE LAWS AND RULES ANO WAULATIONE OF THE SAN JOAOUN COUNTY.HOME OVpNM OR LICENSED AGENT'S SIGNATURE CERTME@ THE PMO'MNO:•1CFMIPYTNATNY PEISOrSLAAIOE ORTNEWOq(pRWSSCN T}Rq P4T1141T M MSUED.I NUILL NOT WPIDr AJtY P[RSON N SUCH A MANNIA A9 70 E FULECT TO WOWMAh I COMPENSATION LAWS OF CALIVOIR` �-CONTRACTOR@ HIIr1O OR BUSCOIRRACTINO SIGNATURE CORIHEe THE FOLIAVAN ETRRY THAT'N F OF TILE WORK FON 1\IIIICII TMS pEFM f IS OSLO.R SHALL EMPLOY PERSONS @USJECT TO SU&CM NSA LAWS OF CALFOR►RA.•T T AWAXCE FOR ALL R[OIAR v wwwrIons.COMPLM DKOVING SELAW, Vmfc y�C, 71TIE:� .� RATE: RI BNED PLOT PLAN RLNIA SCALE •10 A.LOCATION OF NOUS!BFWM)E D1S'OSAL SYSTEM OR PROPOSED I."MAS OF STPE ETS OR ROADS NEAREST TO OR BOLRIONO T/Y PROP em. ExPANSION OF SEWAGE OMPOBAL SYSTE/AS. 2.DUTCH!OF TH!PROPERTY.W1TH OIMENSONS ANO NWRH DIRECTION. E.LOCATION OF VIEW WSTR@N RADNS OF ONE HUNDRED,FIFTY FT.ON J,OOAOM)NED OUTLINES AND LOCATION OF ALL OUSTING AND PROPOSED MUCYUES. THE PROPERTY OR ADJODBNO PIOPtlRV. BPCLUONO COVERED AREAS SUCH AS PATIOS,DRIVCWAYS AND WALXS. : ....... ......: .. : fiti•• Kx$ . �,a • .. �.......... ...... .....p........ ... ....: .......:.... ., ....:.......... ....n....:.. :.... , ' ....... ... .:. ...;.....E f `. _ , .................d......,...�.... .. .'... ...... .......:.. _ ... _... spa 1' At >c..:...... ........:.. ..... : G , :.. _.d.... . :. ' - �- :....:.....:......... 'v I�IAIT LLSE ONLY L ( 2— V C L �~ u APPUCATION ACCEPTED e!' DATE:N@PEOAU3 I✓ , _� ! IN BY TANK.PIT OR SUMP NDATE 1 FINAL CTI VICTION BY \'Yk W ADDITIONAL C DMMENT6: ACCOUPTiNO oNLr: AOS PACJ CODE Fm IrIO AMOUNT -CIIEC FASH RCCSNm BY DATE MR;POWAT MINIM INVOICl1 wj 130 31 q, 11 s g 25 PLD.n &tM SMY.-E-vo.174 CW96;