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APPLICATION FOR LIOUIO WASTE PERMITnn SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES V 01 5-(p ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 93202 (209) 4684UN NOIFNEFUNOME PERMFT EXPIRES 1 TEAR FROM DATE 1XIME0 IGBgIP1G IS TrIMRMM) AP'PUCATION 10 WRESY MAD[ TO THE PAN JOAOLMN COUNTY FOR A PEANUT TO CONSTRUCT ANO.OR INSTALL THE WORK OESCRIN , TNS APPLICATION IE MADE IN COMRIANC7 WITH NAN JOAOIIN COUNTY OCYBLOFMENT TTRLL CNAPFl 0-1110., AND TH[ STANDARDS OF WV JOAONN COUNTY KMX WALT H 1INCBL UMEDNMSWAL HEALTH ORNSWIC JOB ADMOWOR�APNN. sem�/ f/�+�Se�S/'c>�✓ eN+�e �G� �L+OTTMSE OWrOYS NAME iPCry ' 4 kk ADDRESS � � .s PIDNR_Z'S/„S� / CONTRACTOR . / /./�� ADMOS �i� i 224 dam. KIG CONTRACTOR _ AdME9f LOCI FIONE rllMll MI TYPE OF SEPTIC WOW NISW ILIStALLAnoN ❑ SpA11UADORI6A � Oon1UeTTLw ❑ PIO SEPTIC SYSTEM PE MITTEO IF PUBLIC SEWEA RM AVAILABLE MTNIH 200 FEET OF SULDNIO,1 N71C TINTNI I I WJM MANY Appk" R F DUTALLATIOM WALL SMVE! RESIDENCE iX COMMERCIAL ❑ oTHEn ❑ MAWOM OF LNNO LSGts:NIMER OP samooME:,�. NUMPIR OF BMPLOYMS: CNARACM OF BOIL TO A DEPTH OF 3 MTE . , f PIT/BUMP BOIL CHARACTER: WATIA TAKE DEPTIt,_ SEPTIC TANSIOKASI TRAP ❑ TYPEAffq CAPACFFV NO. COMPARTME T$ PRO TTEATSICNT RANT Cl VISTARCE t0 MAWT: WILL FOUNDATION FI101'EfTY LSR_,fift5�- UFT STATION ❑ SIZE tYPE Of P�LOAP SAID OIL SEPARATOR !ENCLOSED SYSTEMI LEADNNO LINE Np. •LESNOTN OF LNEe� ��'d DISTANCE TO NEAREST: LYELL.&n�'FOINOATION [[_„ P'ERTRY LINE�,.`.� RLTWI an ❑ WIDTH LENM DEPTH DWANC[ TO NEAREST: WRL POIIIOATION PROPERTY 111E "oum W ❑WROTH tSNOTN____ DEPTH DISTANCE TO NEAREST: WELL R0,11NOAYWW RDPEnrY UNP SEEPAGE PITS ❑ DQTH Q2E W MEEK DISTANCE TO (RAREST: WELL YOUNOATIMN NDP"" LINE SUMPS ❑ wvrH LENoni _ OWN DISTANCE To NEArEGr: WALL NOUIDATIDN PROPERTY UW- Om/OSA FONDS ❑ WCrH LERITH DEPTH DISTANCE TO NEAREST: VAU___ FOUNDATION FL101'ERrH I" 1 "may CERTMY THAT I HAL[ PREPARED THISAPPLICATION AND THAT THE WORE V LL W DONE IN ACCO/DANCE WIT" RAIN JOAOUN COUNTY OIpiANCE7 AND STAT[ LAVA. NA WAR* AND ABDu.ATIONS OF TIRE SAN JOAOUIN COUNTY. MIA ChI NMORUCMKD AGENT'S SIONATUR9 CERTIPIEB TWV FOLLdNNO:'IDORMNTHAT M THE PEIEORMANCP• OF TNEWOIK PORWBRCH TNN PENi1T IS ISSUED, I SNAIL NOT EMRDY ANY REASON M SUCH A MARINER AS TO $$COW GUSJ= TO WORIWAWS COMPENSATION LAWS OF CALFOMnA.* CONrAACTOMS HIFFn ON SUB.ODNTRACTWO SONATURE COTTBM THE FOLLOWING: 1 CtRTGY THAT IN THE PERFORMANCE OP THE WORK FOR WINCH THIS PSIGEr N NEURO, I SNILLL EMPLOY PERSOIN SUL ICT TO WORENUW'S COMPEISATION LAWS OF CALIFORNIA.' TN APPLICANT MUST CALL it Mus IN ADVANCE POR ALL ASMUM MVSFBOf1ONS. IOLWLFr[ ORANIMq MCI". mown X / 7TTTE: DATE:- CI PLOT PLAN WRLAW TO SCALFJ SCALE ' w O 1. NAMES OF STREETS OR ROADS WAREST TO OR SOUNdNO THE PROPERTY. 4, LOCATION OF WKW MWANE DOMPAL. SYSTEM OR PROPOSED 3 t. OUTLINE OF THE PROPERTY. WITH OINUNO iNOlOAND 0.00" OMECTION. "PARSON OP tBWAW pNNVNIAL S1FGTtlAS. .� 1. OR/ENUWED OUTLINES MIO LOCATION OF ALL EXUTON ANO PROPOSED By l S. LOCATION OF WELLS WftNSN RADNM OF ONE HUNDMO IRPTY FT. ON ONO WCLLS CO%WGD AREAS SUCH AS PATIOS. O NVEWAYS, AND WALES, ` THE PIOPEETY OR ARROI NNO M OPOrrY- f •2✓ ....:^.. d. �. .: ..... ..fin. , ........ ..... , . ..... _..� ... :..:........... ..... .. RIARONMENTAL H .... .... �y (j�} FOR DEPARTMENT LME ONLY APRJCATION ACCEPTED SY Y lY - DATE: ,..._A TANK. PIT On SOME OWECTIO14 BY DATE I �I �,�„• FINAL 1RNBPECTON BY trr'TRAT , ADOITIONALCOwr0411: L II• - NE+A N ffir- .EA.TOOLI ACCOUNT” ONLY: A D+ PACS I4 c00E paw" AMOUNT PvMHTBD ABH RBCSIVSD Mr DATE to O P9SLGr ALSY�SR INVGRCE r 11.:� 1n I ! t sP n -l I,h 4---�A(4 -_ A -2" I J PUC. WPSB11 SIN. , EYIYirO. 174 (,W) / s R 0 0 19 y Z 11