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LA1d\f0' R. t . _ a,-, bt . • . 6- 1 1 ..,:—.. • • • .•• 1 - _. , r- 1 , co• . P ' c> $ ° (A — , S .1 - r. • • • • 1 ,: ; '0 ..... .H. i . c- 5 ?-6/ 10.401-4 540 ",)104 v4 ra PAYMENI pg-r-41 11"•-r' SEP 1 5 1995- :z:AN -JOAOLIIN ' • •Pc•JFILIO HE-ALTH'SEAVICF• ciV•VRONIME.NTAL 4IEFIL TR APPLICATION ACCEPTED BY FoR oEPARTMENIT USE ONLY DATE: - 1S TAW. PR ON SUMP INSPECTION BY OJ mai_ oebtrAnti • ADDITIONAL COMMENTS: APPLICATION FOR LIQUID WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX MI, 445 N. SAN JOAaUIN ST., STOCKTON, CA 99201-031111 (2091 4813420 NOR-REFUNDABLE PERMIT EXPIRES I YEAR FROM SITE ISSUED ICounplets ia TrIAllsatml APPLICATION RI HERESY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT MOOR INSTALL THE woRK mous/ED. THIS APFUCATION IS BLADE re COMPLIANCE WT114 SAN JOACMiN COUNTY DEVELOPMENT WELL CHAPTER 9-1110.3 AND THE STANDARDS Of SAN JOADUM COUNTY PUMJC HEALTH surocEs. ENVIRONMENTAL HEALTH DIVISION. JOB ADORESDOP APN/ : i 3 s--- A U vi in-ri t2, JO CITY eh a ri 4. 44-4 Lor on I ii• C" OWNER'S NNE 0-A-P-1.1 rl .1 PR rirt 5 ADDFIESS li 49C0 (P C' q ..,y ( 1.4!) CONTRACTOR ,e. :r-Li ILA(' Ar.REss Pr) le gy 4G-D uc. 6 en-s-s-id RIME a-yi -77,3 SIM CONTRACTOR ADDRESS LICE MIONE INDEED X DATE: 5 TYPE OF SEPTIC RORK: NEW DM TMIATION ilr REPANIUMIDETION 0 of.sinuenom 0 i NO SEPTIC SYSTEM PERMITTED iF PUBLIC SEWER IS AVAILABLE WITI4IN 200 FEET OF BUILDING I 1 MC TESTUI I I HON MANY ApplsSon / INSTALL/MON WILL sarVF PEDIDEliCE er COMMERCIAL 0 OTHER 0 e NUMMI OR WANG UNITA ( NUMMI,' OR SECIROCr. ').. WAINER of IMIRDWEE OF CH PIT/SUMP SOIL CHARACTER. t`r.+Vid ARACTER SOIL TO A DEPTH OF 3 FEET . 3., •Nor WATER T ADLIE 'DEPTH NORIO TANKAMEAAE Ems OTYPEAIFG p 1-1.- C-nitctod-e-- cApAcrrY L ;.- n it NO. COMPARTMENTS a 0 nJ PIED TREATMENT PLANT 0 DISTANCE TO NSA WELL t MMT FOUNDATION 1 b . rsionare IJNE_LIVL_ LOT STATION 0 au/ TYFE Of PUIM BAND OIL SEPARATOR !ENCLOSED SYSTEM LEACHING UN! in NO 4, LENGTH OF USSR . -. Li cs FOUI4DATION al::, 1 (0 ' DISTANCE TO NEAREST. will La, Iti' FILTER ISO PROPERTY LEND pRopErtry IRE 0 WIDTH DEPTH DISTANCE TO N EAREST: WELL MOUNDED LENGTH FOUNDATION 0 050TH LENGTH DEPTH DISTANCE TO NEASIST . WELL 1J ,F0 .N13Ano TIO4N PROmFEpeRTY.,Uur4E NE EEPAGE PM 0 DEPTH AN WI NUMBER DISTANCE TO NEAREST . ma .. .). UMPS a(MOTH___./_, LLNOTH. DEPTH________ DISTANCE TO NEAREST WEU. LCHO ' FOUNDATION i-to PROPERTY UME I n 1 OMPOSAL PONDS 0 W10411 LENGTH DEPTH DISTANCE TO NEAREST. WELL FOUNDATION PROPERTY UNE I MEREST CERTIFY THAT I NAVE PREPARED THIS APPLICATION AND 1NAT THE WOW HELL BE DONE El AcOOROANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS, AND PWLE0 AND REGULATIONS OFTEN SAN JOAouiN cowry HINE OWNER ORL•COMED AGENT'S SIGNATURE CERTIFIES THE FOLLLNAND N CERTIFY THAT IN THE PERFORMANCE OF THE NOM Eon wyi oC H 01411 PERMITS ISSUED. I SHALL NOT EMPLoy ANY pERsoN IN SUCH A MANNER AS TO BECOME SUBJECT To wORAMAN II COMPENSATION LAWS OF EFJJPOREILA..• CONTRACTOR'S ERRING OR So.CONTRACTING SIGNATURE CERTIFIES THE FollowiNG. 1 CERTIFY TIIAT RI TIE PERFORMANCE OF TIE WERE FOR WHICH THIS PERMIT IS ISSUED. I WALL EMPLOY PEREONS SUBJECT TO WORENIAN'S COMPENSATION LAWS OF CALIFORNIA.• THE ARNICA/IT MUST CALL 24 NOIRES IN ADVANCE FOR ALL NEOIMEED INSPECTIONS, COMPLETE DRAWING SEWN. gir)JILL PLOT FLAN CRAW TO SCA/E1 SCALE NA/i/Es OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTy. OUTUNE OF TIE PROPERTY, WITH DIMENSIONS MC NORTH DIRECTION DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, INCLUDS. COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALK S 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR FROPOSEEI EXPANSION OF SEWAGE DISPOSAL SYSTEMS. E. LOCATION OF WELLS MINN RADIUS OF ONE HUNDRED FIFTY FT ON THE PROPERTY OR ACVOINNO PROPERTY ACCOUNTING ONLY. ND/ FACE r Pi CO,J. PER INFO ANIOUNT IMP REMITTED /C RECEIVED EY DATE OA !MART MAIM INVOICE I L -2-ii Igo [50.M 0,1 --AC,6 .3o.5 7 R000nz 11