|
TYPE of *ITEM WORK: NEW MISTALLATTOOIX
<br />
<br />POINNABOTTIoN II otaratnnea
<br />340 IEPTIC SWIM PERMITTED IF PUBLIC SEWER IS AVAILAJILE WORM 203 FEET OF SUILIONO3 NSW TENNI I I MVO MANY
<br />ApileoNs •
<br />BATE: MU:a_ &rf7)
<br />..... . .... ......
<br />PLOT PLAN DRAW TO 91141.E1 SCALE • le
<br />4. LOCATIoN or HOUSE SEWAGE ompoliAL SYSTEM Oft PROPOSED
<br />EXPANSON Of SEWAGE 125e0441. SYSTEM&
<br />LOCATION OF will) NITTHIN RADIUS OF ONE NUMMI PIETY FT. ON
<br />THE PROPERTY on ADJOINING INIDPOITY.
<br />. .
<br />.... ..... ........... ; . .
<br />NAMES or sTREIT* CR ROADS NEAPEN TO OR BOUND/NO THE PROPERTY.
<br />OUTUNE OF THE PROPERTY. WITH INMENPON. AND NORTH DIRECTION.
<br />DRIENSIONED OUTLINES AM LOCATION OF ALL MGM° AND PPOPOSED STRUcTuTIES.
<br />INCLUDING COVERED ANUS SUCH AS PATIOS, DANGWAye, AND WALKS
<br />'
<br />„
<br />,
<br />:
<br />\ . i . ..t ..... i ., - • ; ;
<br />/0 — OgiA • • • • : " • ... • • - PAYMENT •
<br />. . i RECEIV''"`P• . ,
<br />1.jL1jI 15 1 . :
<br />;
<br />SAN ilAGAJ. .E.:4...LiFift:
<br />.PIthAl, _ALTE, . "Tmual
<br />: vrnOrJMFNrAt.HLTH ofyisioN
<br />:
<br />. •s•
<br />;
<br />! !
<br />.. •••••i- . •
<br />. . i'• '
<br />.--n" APPLICATION FOR LIQUID WASTE PERMIT
<br />SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES
<br />... ENVIRONMENTAL HEALTH DiVISION
<br />304 EAST WEBER AVENUE, STOCKTON, CA 95202
<br />(209) 468-3420
<br />ifl-U
<br />ti_prj , 7(.) 3 C) 30 o '7
<br />lfl NoNDRE A ',MITT EXPIRES I YEAR FRAM MITI IsSUI0
<br />ComWm Is Tripleslei
<br />APPLICATION IT NOLEN MADE TO THE ILAN JOACMIN COUNTY FOR A PENINT TO CoNNNUCT MINOR pan-Au. Tl•re WORK MICRON D. MN APR/CANON IS MADE IN CINARJAPICE WITH sAN
<br />JOAOUIN COUNTY DEVELOPMENT THU. CHAPTER 9-1 110.3 NW MN STANDARDS/ P SAN JOA COMFY RAM HEALTH SCANNER NEVIRONMENTAL HEALTH DIVISION.
<br />JOS AOCRIGNOR Ante i "/.. C. W if --, 6:4 /21..X9 a cm: --S--`74ex-i-.--+-An-i wt. azt,120 Ace
<br />OWNER'S NANA 4e:,...4-/it.T.,/..4 e...4.41[../ ;^ Ge_..1 0.00PEILA.,00,4-41---- PIKNE54eZ. 4/6 510
<br />coffraacroa /6 "c-1:4 ..2.4.-/X "2:41,t9/91 r; C.,1/4/ At:tomesA )1..e2... _,,t- /4,1,4.7 ...1,--6" uci 7rgq 9 25 pwmf,5..."
<br />KM CONTRACTOR ACCRES S LICE /ANNE
<br />INSTALLATION WILL IThVCI RESEDINCI: k, COMMERCIAL D OTHER 0
<br />MAIM OF LAMM INNS: .1 RUMEN Of SEDROENNI: V..-- NAMES of IMPLOYEEIL
<br />04.MIACTEIT OF SOP. TO A DEPTH 0P2 FTEETX4.1,eix.4.1YFT171111AP SOIL CHARACTER C. L C••••-* WATER TAALE DEPTH___&1" t'
<br />WIN TANK/MEW TRAP 0 TypErLos 40 dAt9 2 .C..- c.Apacrry /SEC. e/C) NO. COMPARTMENT* --2---
<br />ISCII ONATMENT RANT 0 DISTANCE TO NEAREAT: WEIL FOUNDATIoN PROPERTY ME
<br />ES'? STATION 0 SUE TYPE CF PUMP SAND OIL *EPA/1MM coquette wrattto
<br />....,..,
<br />LEACMPIG LINE " NO. • LENCITH or toots V.,... - <,,,,,) r CMANCE TO NEAREST! WELL,V-C., FOINDATIoN_1,1E'PPOPERTY LEE
<br />ASTOR MD LI war H MATTH DOTH DISTANCE TO NEAREST! WEIL FOUPPATTON PPCIPENTY LINT
<br />uOUNDED 0 wart. LENGTH DID,TH INSTANCE TO NEAREST: WEIL PO LOCATION RIOREITTY IMF
<br />1 NONA 1ST* Agrutpt. 1.-5— on ET 77 NUMBER "1.-•••• tACTAME TO NEAREST; voru.Zre, i RILMOATION 2....ô '- ecortfire LINE
<br />NAOS 0 WIDTH LENGTH vevri4 DISTANCE TO ERNEST: WELL_............_ FOUNDATION PROPERTY IJNE
<br />OISPOSAL PORN 0 VOIRII MOTH DEPTH DISTANCE TO Olf.AIl IT, WELL FOUNDATION FIENMEITY LINE
<br />I HERESY CERTIFY THAT I HAVE PREPARED THIS APPlicATNN AHD THAT THE WOFK WILLS? Dot* IN ACCONIANCE VEIN MAN JOAGOIN COUNTY OPOINANCES AND STATE LAWS AND NEES
<br />INIBULATTONS OF THE IAN JOACIUNICOUNTY. HOW (TWINER OflUcENsED AGOrrs OtaNATUff currews THE PD ICENTIFy THAT IN THE PERFORAANCE OF THE WORE FORM/NCH
<br />THIS PIERIAIT S ISINAD, I SHALL NOT DEPLOY AM, PERIoN IN SUCH A TANEEN AS TO SEMEN SUBJECT TO WOFKMAN, COMPEMILATIoN LAW* Of CMJSONNIA..• coNTRACTINNE HWANG ON
<br />TUB-CONTPACTINO SIGNATURE CERTIFIES THE FOU.OW,WI, I COMFY THAT IN THE PERPONIAANCE OF THE MOAK RYA WENCH THIS PENATT IS TOWED. I SHALL EMPLOY RENOIR ITVILIECT TO
<br />NOPRAINIII CON ESATIOPI LAWS OP OALIFORYLA.• THE APPLICANT MUST CALL 24 HOME IN ADVANCE FOR AM Iwoursto etweenoma. COMPLETE DRAWING MOW.
<br />fon DEPARTIAINT use ONLY
<br />APRJCATION ACCOTED SY •,(214'-' DATE: 7 1 -11 A ht
<br />DATE FINAL INSPECTION
<br />D
<br />
<br />SY F..0 CiliTZTADATE /
<br />ADOITIMAL CONSAFJIT
<br />ACCOIAMMAD INAT: NO T.
<br />ICI
<br />C? 9 0 z..-2..-3
<br />PE CO, FIE Roo AMOUNT amyl-no CIECKEN NTH PLOWED ST DATE III / MEW WWII NEVEM II 1
<br />1 0 1 / isb_sie 3''7? ),G,-- -7 fi 5 — _ 4 . .. .
<br />' 1 II • • ...
<br />Pub. Health Sem. • Enviro. 174 MAC
<br />NT OR SOUP inspECTIoN SY
|