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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 00`/qs- ENVIRONMENTAL HEALTH DIVISION P.O.BOX 388,344 EAST WEBER AVENUE,STOCIMt4.CA 95201388 (2091460-3420 RON REFUNDA9EE PERMIT EXPIRES 1 YEAR FROM GATE ISSUED ICgoplote In Dipli-pl APPLICATON NI MOWRY MADE TO THE SAN JOAOLRN COLNFY FOR A PERMIT TO CONSTRUCT ANDfOR NSTAI L INC WORK DESCRSIED.THIS APTIICATIDN If MADE N COMRIAWA WITH SAN JOAGUN COUNT'DEVELOMENT TITLE.CHATTER 9.11 10.3 AND TETE STANDARD{OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.—VOWAENTN HEALTH ONINON. JOB ADOPEe{roR ASN/ -& ,2 .PGI/ 'a CITY LOT W71 ow ER'1 NAME /1 IU �, ADURFSB 4� le- 7, Raaf__ COWFLACTOR4 ✓✓ , r!''�// 5,e..- ADDRESS P,I'��' G iC/J TN.2c�F7_ _ucF PHaNE�r's��iT 1�1 J J / BUB CONTRACTOR ADORE98 LICE PHONE TYPE OF SEPTIC W04W: NEW INSTALLATION❑ REPA{VAD Y10N X OnTmmmN❑ NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IB AVA RJALf WITHIN 200 FEET OF BUILDINn.I PIPIC TMiNI 1 1110W M.MNY APMa.11nn NSTALLAFION WRL 96nE: RESIDENCE IA COMMERCIAL❑ TN ❑ NISAB61 OF AMNO UNITS! g VISAS 61 OF■m1100MB: LEN 6H EMFIO YFFB'-~_ CHARACTER OF SOB.TO A DEPTH OF 3 FEET: 4 DOZ L/ ATiSUMP SOIL CHARACTER: / WATER TABLE OEPTH j5 SEPTIC TAMUdILASE TRAP ❑TYPEUr�OTTv—; lL. i CAPACITY / Cf'�C>-A� NO.CDMPAMWFNTI PSO t1EATMdT RANT❑ q{TANG[TO MElU1EST: WELL LVyj ..� IOIINOATION�T PmpERr Y UNE LIFT STATION❑ SIE VYPE OF PUMP BAND 4SEPAYLATCA IEHCLOSED SYSTEMA LEACH!"ME A1�1 NO.i LENGTH OF LINES_ � G —TANCE 10 WARE";WELL FOUNOA/N)N PROPERTY LINE FILTER SED LI,WFOTH Sl lFNG1Hy��MPTN /n'�/DISTANCF TO AEAFIEST: FOUMDAT:ON�rrPROMAITY LINE MOUAIDm ❑WIDTH LENGTH_`DEPTH DISTANCE TO NEAREST:)HELL fOUN D!mON PROFENTY UNE OMPMR PITS ❑OEPTN SITE__NUMBER DISTANCE TO NEAREST:WELL FOLW(DATION PROPERTY LAE SILIM ❑WE)7N LENGTH _DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY lNE d{"BAL"NOS ❑WIDTH LENGTH DEPTH DISTMCETO WAREST:WELL :-0UWUkTION PAOPERTYLIE I HEFENY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND IHAT THE WOW WALL BE DONE N ACCORDANCE WITH BAN JGAOUIN COUNTY OFONANCfS AND STATE LAWS,AND RULE; J A/U IEOUTAT1ONS Of IN' JOAQUIN COUNTY.HOME OWW R OR LICENSED AGENT'S BIONATUNE CERTIFEB THE FOLLOWING!'I CERTIFY THAT N THE PEAFDM. C OF INC WORK"RWUSCH THIO PERMIT 41SWED,1 SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME BUBJECT TO WORKMAN'S COMPENSATION LAWS OP CALIFORNIA.' CONTRACTOR'S"Won OR J SUBCONTRACT'Z,NGNATUIIE CERTIFIER TIME FOLLOWING:'1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR NE:IGII TNSS PERMMI IS ISSUED,I SHALL EMR OY PERS"SUB.ECT TO WORKMAN'S COMPENSATION LAWS OF CALL"RNA.' TILE APPLICANT MUSY CALL M NOESIS IN ADVANCE FOR ALL 11ED.URm MNSPICTION{. COMFIITE DRAWINO SELOW. rrtLE:� GATE: R07 RAH IDMW TO SCALE,SCALE I.NARES OF STREETS OR ROADB W AREST TO OR BOUNDING THE PROPERTY. S.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED (� 2.OUTLINE OF THE WITH TH DIMHm DIMENSIONS AND NORTH DIRECTION. EXPAON OF WWA(E DISPOSAL SYSTEMS. J 3. DIMENSIONED OVTLWS AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURE 0, 1.LOCATION OF WELLS WITHIN RAO U{OF ONE HUNDRED HFTY FT.ON INCLUDING COVERED ARE"SLICH AS PATIOS,DIEVEWAYS•AND WANKS. THE TfXERTY OR ADJONNO PROPERTY. .....�. _. ..... .. .. i.. .......... j. ...... x Q TAN .. ....'....,. . t .. i ... ..I .IO .. .. f. _..P1'fYaR#Eq;.. tp A 7 2997 SE /+ SAN JOALXAN ot:, Y I Y IPJ 1'I l(�F" PLIEIUQ HEAL H SEPt,10E . rpNvlAQNb1EN7AL HEALTH 4)rV On FOR DEPARTMENT USE ONLY AFTTIC ATTON ACCEPTED SY` OAT F: ARRA: a) {� TALK,PIT OR SI)W INSPECTAON eY DATE J 1 FNAL INSPECTION SY L,.l ! GATE L l/'J/I�I f �� I (� R AOOITIONAL COMMENTS:�J<V AIS 4� LL 1Y��I{.'E�/-C�--'`'(\��'�i �fN S_ �1(W iLI .I,I• IC �,T�t.� A✓L Nl-E 1-Li ♦.L 77Laa r4+�+'a. hI WL1/4 AL G C••F aCF. Y: ACCOUNTING OMIT: -1 FACT -�[ FLI'IL1l♦l u (JLY1t - PECOOE I —..I. AMOUNTREMPIT- UJECXACASH RECENED AY RATIN Ml FBYF NKNNI nomcs0 r a Pab.Health Sen. Elwilo.174(31K L