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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Z ENVIRONMENTAL HEALTH DIVISION P,O. BOX 388, 304 EAST WEBERMSNUE, ST•OCKMN, CA 95201386 b�� 1209) 462-3420 C(Djb MON-AEFUNDABLE PERMIT EMPIRES 1 TEAR FROM DATE ISSUEDE rAmplata ti Trfpffcatal APPLICATION IS HEREBY MADE TO THE SAN JOA All N COURfTY HOPI A PERMfT TO CONSTRUCT ANWOA WSFALL THE WOG( DEI)CPHIED, THIB APFUCAT ON M MADE IN CO—A NCE WRV, SAN JOAGUIN COUNTY OEVELOPMENT TrFLE CHAPTER 0-11 Ma AND THE STANDARDS OF RAN JJOOAACON COUNTY PVYUC HEALTH SERVI I IRONARNTAL HEALTH DIVISION, JOS ADMUSOOR .TRIC ( q L4 _ Iv e\ II ! E{�'j1� E/" 1/' - ( CRY LOT Ste' -� OLNvETI'S NAMERojkG ADDRESS b"P�-i- / n PHONE :� � 3 -,65 - CONTRACTOR ✓"r Ee--- ADDRESS }. �P�a L1CejQQT�S -I PHONE�)39-77-1.I HRS cONTRA.CTOR ADDRESS LICE PHOW TYPE OF SEITIC WORK: NEW INSTALLATION RF}AIRfADOfnON ❑ DE/Tml mm 13 MO SEPTIC SYSTEM PE?WfTTED IF PUBUC BFWER le AVAILABLE WfTHIN 2DO FEET OF BNLOINO.I RAO TISTI.) I I FIOW MANY �(/ APPSullon INSTALLATION WILL 49ME PEBIDOW1 Cl COMMERICIAL ❑ OTHER ❑ NUpAlm LIVING DROUMS Of wArwyms: CKU%&CTER OF SOILS TOT A D�pp7 �FEET� OF S �T y.� P SOIL CHARACTER! �+.+�+I EA' WATER TABLE DEPTH S!"TIC TAMKAN ASE TRA" LJ IYI'E "G f le I CAPACrTY�640 I NO. COMPART1•ENTB PKG TAEATMEMT RANT 11 DISTANCE TO NEARiIT: WELL S (� FOUNDATIONS -V PROPERTY LINE, fEQ LFT STATION ❑ �GIZZF. TYPE OF PUMP SAND OIL SEPARATOR (ENCLOSED BYBTEMI f LSACIaNG LWE IIt-T LA0. S LENGTH OF LIN EA^3 ^t ry OOIST-ANCE TO HENIEBT: WELL 10 _ PROPERTY UNE RUIN S®0 WIDTH LEN ITT H DEPTH DISTANCE TO NEAREST: WELL FOUNOATNON PROPERTY LINE M.L*m ❑u/WIDTHLENGTH_ DEPTH DISTANCE TO NEAREST', WELL_ FOVNDATKIN—-F-PROPERTY LINE S@AOI PITS I._SIZE_"-_ QT NUMBER _ DISTANCE TO NEAREST: WELL 100 _ FOUNDATION PROPERTY LIME ILSY"t Cl WIDTH LENGTHDEPTH DISTANCE TO NEAREST: WELL FOVNOATION PROPERTY UNE ---�• DISPOSAL POND'S ❑ WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE n .... I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND TK -,T THE WORK WILE BE CONE IN ACCORDANCE WIN SAH .SOAGUKN COUNTY OF"NANCES AND STATE LAWS, AND MALS / MND REGULATIONS OF THE SAN JOAOl11N COVNTY. HOME OWNER ORL)C :LASED AGENT'S VONATUHE CERTIFIES THE FOLLOWING'. 'I CERTIFY THAT IN THE PERFORMANCE DF THE WORK FOR WHICH RA.' COHTCTOR'S WARM OR IF"PEFOW It ISSUED, 1 SHALL NOT EUKOY ANY PERSON M SUCH A M.WNETI A/ TO BECOME SUBJECTTO WORKMAN'S COMPENSArKw LAWS Of CAL"MNM Ou"ONTRACTVG W04ATUFI CERTIFIEt THE FOLLOWING: '1 CERTIFY THAT IN THE PERFOFNANCE OF THE WORK FOR WHICH TWO PERMIT It ISSUED, I SHALL EMPLOY PERSONS SVSJECT TO BLOW /�•-- V,O MAN'l COMPENSATION LAWS OF CAUFORHIK' THE APPLICANT MUST CALL 7A HOURS IN ADVANCE FOR ALL REQiWF��D INIMTIONN'S,, COMPLETE DRAWING 1` U�` �E ! HONED X TRLE:�i]t_�-(`G DATE: �a PLOT RAN IDRAW TO SCALER SCALE _' lu 1. NAMES OF STREET{ OR WADS NEAREST TO DR BOUNDING TRNE PROPERTY. 4. LOCATION OF HOVSE fIEWAOf DISPOSN, SYSTEM OR PROPOSEDT. OUTUNC OF THE PROPERTY, WRH OIMENS7ONa AND NORTH DIRECTION. EXPANSION OP SEWAGE 0{SWSAL /VITEFIS v • ]. DIMENSIONED OVTUNEO AND LOCATION OF ALL EXISTING AND PROPOSED BTNUCTURES, /. LOCATION OF WELLS WITHIN MONS OF ONE HUNDRED FIFTY IT. ON IMCLVDINO COVETED AHEM SUCH AS PATIOS, DRIVEWAYS, AND WALKS. THE PROPERTY OR ADJOSIBG PROPERTY. ACCOUNTING ONLY: RIO/ FAC/ R CODE FEE INFO AMOUNT KwHTED HEC ASH RECEIVED SY DATE SR; P6SAFT NUFAS9R . ..... ..... ..., .. ......i.. .... : n .... : .r • ..tib:. ti wad, f v • �l'� f `t ;...: :.. PAYMENT. ., .. 3 .. i .. .. .. .:.. ... ... .... .......... .., .,. ..;..... .... . ',... ...• ... SAN- U - FOR DE)ARTMENT USE ONLY ENVIPON MENToL HF -4,17H .l; J;;,�• APPLICATION ACCEPTED BY _ DATE: Z AREA: NK TA. PIT OF BUMP RNeP CfFJH . ( SY DATE ADDITIONAL COMMENIS:� �/{ � �j //yy�� 1-1 FINK INSPECTION BY 7 DA1-E ACCOUNTING ONLY: RIO/ FAC/ R CODE FEE INFO AMOUNT KwHTED HEC ASH RECEIVED SY DATE SR; P6SAFT NUFAS9R INVONCE l Z, Pub. Heafth So". - EnvirD. 174 (3196)