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Job Address/or APN* 1/ I-I 7 Owner's Name Contractor -171 Sub - Sub Contractor APPLICATION FOR LlaUID WASTE PERMIT SAN JOAaUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 446 N. SAN JOAQUIN ST., STOCKTON, CA 96281.0388 (2091 468.3420 NON,REFUNDABLE ptnnur EXPIRES I YEAR FROM DATE ISSUED 1ComplembiTtipiketW Application is hereby made to the San Joaquin County for a permit to construct end/or install the work described. This application is made in compliance with San Joaquin County Development Title, Chapter 9-1110.3 and the Standards of San Joaquin County Public Health Services, Environmental Health Division. a L.----0-77Z City Lot St teS 4i-1'e17-" Address 7 f __Phone .tli'75To 9 Address r,{0_0- Lid; i 3_76;7 Phon 1/04,7 ' Address Lid* Phone TYPE OF SEPTIC WORK: NEW INSTALLATION fri REPAIWADDITION II DESTRUCTION II PESC TESIO/II Nem MANY (NO SEPTIC SYSTEM PERNItTED If PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) LAW Use Appliesiumn 8 Installation will serve: Residence Commercial Other.jgetA Number of living units: i Number of bedrooms! Number of employees: Character of soli to a depth at 3 feet: Pit/Sump Soil Charecteri Water Table Depth c, SEPTIC TANIUDREARE TRAP U Type/Nfg P 4. I., CapacItyjAe20 Mo. Compartments 01 P7W TREATMENT PLANT I I Distance to nearest: Well 10() Foundation AC Property line 4 P.-- LIFT STATlONO Size Type of Pump Sand Oil Separator (enclosed system) LEACHING LINE I] No. length of Ilnes j - 44e, Distance to Nearest: Welif_f e Foundation 0_ Property Line FILTER BED i) Width Length Depth MOUNDED Width Length_ Depth Depth 12,1 p El Width Length /6 Depth 7 DISPOSAL PONDS I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinanc.:::: and State Laws, and Rules and Regulations of the San Joaquin County. Home owner or licensed agent's signature certifies the following : "1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in such a manner as to become subject to workmen's compensation laws of California." Cantractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, 1 shall employ persons subject to workman's compensation Laws of California." The applicaatmest gall 24 Iim,Inadvaismsfer all requited limseetiens. Complete drawing below. Ii Width Length Depth Well Fouldation Property Line Well Foundation Propenty Line 11 Qelt rr Foundation ; Property Line Li 5 11 FoundationE c- Property Line Well Foundation Property Line PLOT PLAN (Draw to Seale) Scale " to Names of streets or roads nearest to or bounding the property. Outline of the property, with dimensions and North direction. Dimensioned outlines and location of all existing end proposed structures, including covered areas such as patios, driveways, and walks. Location of house sewage disposal system or proposed expansion of sewage disposal systems. Location of walla within radius of i50 ft. on the property or adjoining property. "'T' r " .4. J . NT 1E1 Es/ED - 5 E P II.• SA ,IOQUIN COL ',I:J. i t \' i'i.r. MI Et4OPONUFN PUBL.. riet,t_TI CAL ii'...P.lj !.- DIVIllY mmiii mu IN __Zept,.._ 7IP ) -C6 =MO tuo ,.$ P ------:-----%"-- , J'f ) —.j. 4 es — g ' EON DEPASTMEAT USE ONLY 9 )1- Title: &,..e.,4,74-4-a-- Date: Signed Application Accepted by rej7."2 Tank, Pit 063_,Irfspection ktfiel Inspection by by F2,41 Additional Comments: Date: 647 Date? / 2.1/ ACCOUNTING ONLY: AID* FAC* PE CODE FEEINFO AMOUNT REMITTED CHECNOSH nEcavto BY DATE 111 !PERMIT NUMBER INVOICES P4.c-c I 14. e:,6 LI cT d 1.2 ri,1Z_ t=izi:itz-- 1-- 1 Se_CO1-1