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( <br />, 14.(-4-4-t"'; <br /> E G 1 1596,' <br />171Egi. I ...... <br />003 2'1 <br />APPLICATION FOR mum WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 95201488 <br />12091 488.3420 <br />PO/I-REFUNDAREE PERIM' EXPIRES 1 YEAR FROM PAU issum <br />fRamalata Is TripliestsI <br />APPUCATEON IS HFprey MADE TO THE SAN JOAQUIN COUNTY POE A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCENDED THIS APPLICATION he MADE IN COMPLIANCE WITH SAN <br />JOAGUIN COUNTY DEVELOPMENT TITLE. CHAPTER a- / 110.3 AND THE STANDAMG OF SAN JOAQUIN COUNTY PLIBLIC HEALTH SERVICES, ENVIROMISENTAL HEALTH DIVISION. <br />JOS ADDRESS:OR AIDS c•-• 76TO &O ---7e2(744 CRT / <br />CONTRACTOR ADDRESS /2/ r <br />Cr) <br />cs-- <br />SUS CONTRACTOR ADDRESS <br />TYPE OF SEPTIC Wank; NEW INSTALLATION 0 <br />1140 SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN <br />INSTALLATION WILL SERVE <br />6/ <br />RESIDENCE COMMERCIAL 0 <br />MINIM OF LIVING UNITS; HIRAM OF BEDROOMS: <br />TAPAIRADDITION °name-non 0 <br />/00 FEET Of SUI WSJ <br />'// <br />OTHER 0 de/P7F, Cv ea..-•Ze/ <br />POW RESEW ( <br />APPEoMlor • <br />I NOW WINE <br />MUMMER OF ERApLoWss. <br />DEPTH. v,215 CII R OF SOIL 70 A DEPTH OF 3 FEETC0;74.2..r.- PIT/SLIMP PCB CHARACTER , WATER TAGLE <br />KJOIREASE TRAP 0 TYPETIAD3 L,Eia - "P. cAFAcrrY 621=I0 NO, compAgrmarre <br />RICO TREATMENT PLANT 0 INSTANCE TO MEANEST: WELL FOUNDATION /C2 pito/Awry UNE <br />EFT STATION 0 SITE TYPE OF Poo? BAND 09, SEPARATOR (ENCLOSED SYSTEM, <br />pRoPEFITY LINE LEACHING USE 0 ••.• LENGTH OF LINES ONITTANCE TO NEAREST: WELL FOUNDATION <br />FILTER BED >t/ WIDTH 8).0 ' LENGTH_ VC' / DEPTH 92 DISTANCE TO NEAREST, WELL /04' FOUNDATION 2e9 PPOPERTY LINE /0C)/ <br />mouNDED 0 WIDTH DISTANCE TO NEAFIESTI WELL FOUNDATION PROPERTY UNE <br />SEEPA RTEGE <br />LENEITN <br />0 DEPTH ME <br />NOEPTSI <br />UMBER DISTANCE TO NEAREST: WEIL_ FOUNDATION PROPERTY UNE <br />SUMPS 0 WIDTH LENGTH !RIPEN INSTANCE 70 NEAREST: WELL FOUNDATION PROPERTY UNE <br />DISPOSAL PONDS 0 WIDTH trwani DEPTH DISTANCE TO NEAREST, WELL FOUNDATION PROPERTY UNE <br />I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOPIL. WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS, AND RULES <br />AND FLEGULATIONS OF THE SAN JOAQuIN cowry, Hose OWNER oR UCENSED AGENT'S SIGNATURE CERTIF ES THE FOLLOWING, 10ERTICYTHAT NTH( PERFORMANCE OF DEADEST FOR WHIcH THIS PERMIT IS ISSUED, I SNAU. NOT •Y ANY PERSON IN ERIC MANNER AS TO SEcOME SUBJECT TO WOFAMANT COMPENSATION LAWS OF CAUFORNIEL. CONTRACTOR'S IMMO OR SUS-CO • SIG T' S FOLLOWING: 'I 'THAT IN DO PERFORMANCE OF THE WORE FOR WHICH THIS PERM/7 IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORK IA.. CALL, 24 NOME IN ADVANCE FOR AU. PLECKARSD pancrie.s. COMPLETE DRAINING BELOW. - <br />OWFRS NANocctt: C044 V u1 /4441 ,6A, ADDRESS 544/Pa_ PHONE 3 3.-C- eJ2 Si 7 <br />LOT SIZEL <br />PLOT PLAN DRAW TO SCALE SCALE <br />NAMES OF STREETS OR ROADS NEAREST TO OR aomomal THE PROPERTY. <br />OUTLINE OF THE PROPEATY, WITH DIMENSIONS AND NORTH DIRECTION. <br />DINENSIONED OUTLINES AND LOCATION OF All EXISTING AND PROPOSED STRUCTURES, <br />INCLUDINO COVEPED AREAS SUCH AS PATIOS. DRIVEWAYS, AND WALKS <br />E. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEN OR PROPOSED <br />ESPASIBION OF SEWAGE DISPOSAL SYSTEMS, <br />S. LOOMED., OF WELLS W/TWN RADIUS OF ONE HUNDRED FIFTY FT. ON <br />THE PROPERTY OR ADJOITONO PROPERTY. <br />APPLICATION ACCEPTED BY <br />DATE: <br />7 <br />• <br />1 <br />; <br />'etir: p <br />)00 <br />EL <br />7470•t71-07 <br />Et, <br />FOR DEPARTMENT LASE ONLY <br /> /77 <br />/ FINAL INSPECTION BY <br />ADO <br />t ....4,,t47-e ELATS/4. T di ,/ 7(.• TANK, PIT OR GISAP INSPECTION BY DATE I <br />443 TTIONAL cUMMENTS C-2/24,..A.J25) 1/4.121.4...CL CA"-, r-1 Ata...4...6 <br />._. <br />ACCOUNTING ONLY: AID/ <br />....___ FACE' <br />• <br />SE CODS FEE INFO AMOUNT ROSITTED Ann RECEIVE:. BY DATE AR I PERMIT INUNNER INDICESI <br />• II . .A4r.EASIIIIIIIMIIII.A. ll <br />. ......../....-- 03 <br />_ 5g001 1 ?-/-7 s <br />.......