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APPLICATION FOR LIQUID WASTE PERMIT CT} <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ��JJ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> NOWADVII0118tt PjNWrPIRE3 I YEAR FROM DATE ISSUED <br /> t1'.DdT11E0 In TEpRaEDI <br /> APPLICATION 17 HERESY MADE TO THE DAN JOAOUDI COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS AFRJGATION 19 MADE IN COMFUANCE WTH SAN <br /> JOAOUM COMM OE14RDPMENTT TITLE.CHAWMR 9-1110.3 AND THE 1fTAFN{A/I/r/S/ r SAN.RIAp/RP/�COUNTY FUNIC HEALTH SERVICES.ENVIDPEEHUTAL HEALTH DIVISION. <br /> JOS ADDRISSAR A'Wl Z . -'/ /� Lrf/� ![!!1�DO/1 CRY SUIS SI2Ey <br /> OWNER'S NAME <br /> CONTRACTOR/e( 88 UC, <br /> SUe CONTRACTOR GODLESS Lics PUISNE <br /> TYPE OF SEFTIC WORK: NEW IHISTALLATION RVAMAODRTION ❑ DSSTRUCTNON❑ <br /> IHO SEPTIC SYSTEM PERMITTED F PUBLIC SEWER IS AVAN.AN E WITHIN ZOD FEET OF OUN DING-1 PERC TUTIO I I WJW MARY <br /> APPS�P4e <br /> INSTALLATION WILL SERVE RESIDENCE k K:OMMEscm ❑ OTHER Cl <br /> NUMBER OF WING UNITS: NULE&ETt OF SEIDgOM/SS:�_NURNM OF MP OVEES: p <br /> CHARACTER OF SOX TO A DEPTH OF 9 FEET:��i�fG�3�PFE UMP SOX CHARACTER: 'C.t Gtr WATER TAGLE DMIL� = L ` <br /> 4001M TA16MMEASE TRAP ❑TY uwn Ir CAPACITY NO.COMPARTIAENTS V <br /> PKO TREATMENT RANT❑ DISTANCE TO NEARIUM WELL FOUNDATION PROPERTY LIVE <br /> LIFT STATHON(3StrE TYPE OF PUMP SAND OX SEPARATOR(ENCLOSED SYSTEM( <br /> LEACHSIHG UNE NO.[k LEPOTH OF LINEBf� S IJ f dYrANCE TO NEAREST:WELL FOUPIOA7DN�I PIIOPQRY UNE <br /> NLTER BED 0 WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOU94)ATION PROPERTY LINE <br /> MOUNDED O YVNDTH LENGTH bEPTH DISTANCE TO NEAREST:WELL FOUIDATON PROTY LINE <br /> &SIVAUR TRS WDVTH � SIZE ���NUMSER -t-- DISTANCE TO NEAREST: D J MUWATIDN�� PER <br /> PROPERTY LINE 445P-' <br /> OUL"S ❑WIDTH( LENGTH VEPTH DISTANCE TO NEAREST:WELL _FOUNDAITON FVWPERPT LINE_ <br /> EINFOSALPONDS ❑WDTH Lvam -DEPTH DISTANCE TONEATEETiWELL —FOUNDATION—FROPERTYUNE <br /> I HERESY CERTIFY THAT 1 NAVE PREPARED THIS APPUCATION AND THAT THE WOIK WILL BE DONE IN ACCORDANCE.VJTH(JAN JOAOUIN COUNTY OROMMICES ANO RATE LAWS.AFRO ME$ q <br /> AND REGULATIONS OFTHESANJOAOUINCOUNTY.HW*OWNEHORLK:QVSEDAODVf'SSIONATURECERfFIBTHEPOLLOAgn:9CERTWVTHATINTHE PERPOIWANCEOF?W%VORKFORWHICH <br /> THIS M MUT 0ISSUED.I SHALL NOT EMPLOY ANY PERSON IH SUCH A MJUVIER AS TO SECOM6 SUBJECT TO WORKwwry COMPENSATION LAWS OF CALIFO I IA.' CONTRACTOR'S HIDING OR <br /> SUS-CONTRACTING SIGNATURE CERPRES THE FOLLOWRNO:9 CERTIFY THAI IN THE FERFOIMEANCE OF THE WORK FO'A WMICH TWO PERMIT IS ISSUED.1 ONALL EMPLOY PERSONS fUSACT TO <br /> %vonmAN'S TON LAWS OF CALIFORNIA." I!A.- TAMICANT MUST CALL 24 HOW E FO <br /> IN ADVANCE AL1.RIBOI�b1&MVIONS- COMPLETE DRAWING SELOW. <br /> yy <br /> SIPPED>< TTIE:_ �` _DATE: <br /> PLOT RAPT @RAW TO SCALER SCALE--- _ _ -le <br /> 1. HAAKS OF STREETS OR ROADS NEAREST 70 OR BOUNCING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DWOM SYSTEM OR MMMD <br /> Z. OUTLIVE OF THE PROPERTY.WT1I DIMENPK*M AND NORTH DIRECTION. ERKPANSION Of SEWAGE DISPOSAL SYSTEMS. Q <br /> S. DIMENSIONED OUTLIVES AND LOCATION OF ALL EKISTMO AND FRDPOSED STRUCTUR IEN. 6. LOCATION OF WELLS WTTHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED ARMS OWN AS PATOS DRIVEWAYS,AND WALKS. .. ....s .: .. .--- THE PROPERTY OR ADJOINING FREOFERTY - <br /> .. :. . <br /> .. ...... .. <br /> .. .. . <br /> ........ <br /> .. .. <br /> ........ <br /> . � .. .. ,.. Q . <br /> .. . <br /> .. <br /> M <br /> SAN amu;GUIN C.=�.ONTT <br /> c - r <br /> EAvlRarylvN�lvrA�HEr1Lrft N Lai r� <br /> :.. <br /> ++ fOR DEPARTMENT LIVE ONLY �y <br /> APPLICATION ACCEPTED By //�GT�G/�f'p� DATE: AKA:`�� <br /> TANK.PT OR SUMP INSPECTION SY DATE I I FINAL INSPECTION BY 2,-Z) <br /> 7 <br /> O Tk l,Z)1 <br /> ADDITIONAL COMMEY/TS:f <br /> ACCOUDFFWAONLY, AID/ FACA 13 <br /> PE Corit FTN INFO AMOUNT rAmr D C"WKJKASH RECLTNm Sy DATE PR J PET"T NEMER 111VOOE <br /> o <br /> Sig,6± <br /> P Uh.Health Serv.-Envlro.174 MM) <br />