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(J APPLICATION FOR LIQUID WASTE PERMIT <br />SAN'JOAQUIN COUNTY PUBLIC HEAtTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 388.304 EAST WEBER AVENUE, STOCKTON, CA 96201-988 <br />1203) 4883420 <br />ROWIEFURDASLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />r M fists in TrWit9Tt1 I <br />APPUCATPON 16 NUMNY MADE TO THE SAH JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTAL. THE WORK DESCRIBED, THIS AgVCATIOM IS MADE N COANEJANCE WITH SAN <br />JOAOUN COUNTY LN:YELOPMENT TITLE, CHAPTER B -I 110-3 AND THE STANDARDS OF SAN JOAOUIN COUNTY PN9UC HEALTH BERVILES• ENVMIONMENrAL HEALTH OFN WJN. <br />JOS ADORESSJOR AMU L�F <br />S <br />L. GW <br />t*,, e-, <br />crry EZ S--- LOTT SIZE!' 1 <br />OwNER'I NAME m <br />ct•vrel <br />ch <br />-'—'tel <br />AOORESS S9,✓%='�G <br />/ <br />PHOWE_ D 3a`� as Gy <br />CONTRACTOR fief— <br />It u <br />n <br />AOOf¢SS YC1 vbc, (f, <br />SIO UC/ P"0wF as - 4� <br />OUR CONTRACTOR <br />TYPE OF germ WORK: NEW M49TAUATOM ❑ RVAIVADDITNIN y <br />INo SEPTIC aYBrEM PErWITTED IF Puavc SEWER IS AVAILABLE WrTH N 200 FEET OF our Om.) <br />DGTIIUOTIOM UPAY-Ml'—tm <br />1 <br />P.M E11OT R AEiab'— <br />APSSwaqr t <br />INSTALLATION WLl SSfNG RESRIEWEIIe COMMERCIAL ❑ OTHER 13 <br />NUMMIER OF WINO UNITS: I OF -PA 9L CIF SMDROOMS' 6 M MOM W MIPLOWES: <br />CHARACTER OF SOIL TO A DEPTH OF 9 FEET: PITMAIAP SOL CHARACTER: WATER TABLE '7 JUAO.JI" <br />LG <br />SEPTIC TAMN'a, <br />KEASE TAMP❑ TYPERAFOy CAPACITY NO. £ .1 • <br />PILO T14FATU MT PIAMT ❑ tMTANCE TO TQ.MBST: WELL FOUNDATION PROTiRTr LINE <br />LWT STAMM ❑L SIM —TYPE OF PLMAPT SAND OIL SEPARATOR iENQOSED SYSTEMA ! R <br />LLMCNNO UN[ y 110. i LENGTH OF LMIEi_ 6 DISTANCE TO NEAREST: WELL` -FOUNDATION S PROPERTY LINE V� <br />FILTER IED ❑ WIDTH LENGTH__ DEPTH DISTANCE TO NEAREST: NELl _ FOUNDATxM PROPERTY UNE <br />MOUMDID �0 WIIOTH LE}WTH �I �, 1 DEPTH DIyTANCE TO NEAREST: OAU FOUNDATION PROPORY UNE <br />SSEPAOE ATS Eq MEPrN 1 n' SIZE I /A ALRI WII*t.�y DISTANCE TO NE�NESr: W[tl i CTO POUNDATIDN�RiDFHTTI' I" <br />SLIM ❑ WIOTH LENGTH— 7EP'rH DISTANCE TO NEAREST: WELL FOUAOATION PROPERTY UNE <br />MSP OAAL PON04 ❑ WDTN LENGTH DEPTH 049TANCE TO NEAREST! WKL- FOUNDATION PROPERTY UNE <br />1 HERESY CERTIFY THAT 1 MAK PREPARED THIS ANIXATION AND THAT TM. WpEK WLL RE DOFF N RD <br />ACCOANCE •MN TM SAN JOAOUCOUNTY OMAN <br />MICEO AD STATE LAWS. AND IRMER <br />AND FEOOLATIONS OF THE SAN JOAOUIN COUNTY. HOME OW NEROR LICENSM AOENT'S SIGNATURE CERTIFIES THE FOLLOwnNS: '1 CERTIFY THAT N THEPE/fOANANCE OF THE WORK FOR WHICH <br />T1,09 PFIWIT IS IMBUED. I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AB TO 9E1COME SUBJECT TO WOPRMJW'S COSFPBNATION LAWS OF CA1M'OFELA.' COHTRACTOR'M MWRIO OR <br />BUB -CONTRACTING MONATUW! CERTFES THE FOIIDWNO: 1 CERTIFY THAT IN "INE PERFORMANCE OF THE WOM FOR WISCH TWB PERMIT N ISSUED, 1 SNALL ENILOY!00007/9 BULJECT TO <br />WORKMAN'S COPAKN"TN�N(// LAWS OF CALIFORNIA.' THE APKJCAMT MUST CAL'. 24 MOW IM ADVANCE FJR ALL PTidIM® MFIPECTOMS. COMPLETE DRAWING BELOW. f <br />SIONEDK �M/J_�� TRLE:�611�i-f'G 44--ttr DATE'73 <br />CCC �'P ROT PLAN MAW TO SCALA BCAiF ' 1e <br />1. MAMAS OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATDN OF HOUSE GEWA13E DISPOSAL WITEU OR PFIOPOREO <br />2- OUTLINE OF THE PROPERTY. LVRN DI EMBTESAS <br />NSIONS AND NORTH DECTION. EXPANSION OF SEWAGE DISPOSAL SY. <br />3. DSAENSIONEO OUTLINES AND LOCATION Of ALL EXISTMID AND P11010SED BTRUCTUFES, 9- LOCATION OF WELLS S WrTTSN RADNiS OF ONE HANDFED FIFTY R. ON <br />INCLUDING COVERED AE.A6 SUCH AS PATIOS, DWAWAYS, AND WALKS, THE PROPERTY OR ADJO94MO N1GF'EMY. <br />rwi <br />FR OEPARTM E ONLY )n' <br />APPUCATION ACCEPTEO BY 1� DATE; V NfEA;^ <br />cyT h <br />TANK, PIT OR cUMP INSPECTION By DATE I I FINAL NSPECTION BY '✓ DATES '4 , L t <br />Z n ! <br />ADWIONAL COMMENTR: //f9 Or !n() <br />