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APPLICATION FOR I SAN'JOAU IH COUNTY PUBLIC E SER ICES SCANNED ENVIRONMENTAL HEALTH DIVISION P.O.BOX 388,446 N.SAN JOAOUIN ST„STOCKTON,CA 9520MOO (209)460 420 NOW-REFUNDABLE PERMIT EXPIRES-1 YEAR FROM Ulf fSSUEO jUmpbu iR Tr*kmIW APPLICATION IS HEREBY MADE TO THE SAN JOAQNN COUNTY FOR A PERMIT TO CONSTRUCT ANOAOR INSTALL THE WORK DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WRIT SMI JOAQUIN COUNTY MVROPMEWF TIRE,CHAPTER 11.1110.3 AND THE STANDARDS OF GAN JOAMM COUNTY PUBLIC HEALTH SOW CM kNVIROM&WAL HEALTH ORMIGM. JOB ADDRESS"APNO CFrY �-tav V _ _ LOT A2E��iZL! OWNER•$NAME . a L.'1/N ADDRESS PHONE-5, S-I 3I'-:I_ CO2CAy 73'i PHONE aFP` SUBCONTRACTOR a AooR[s8 urg WIOHE TYPE OF SWITC WORK: NEW INSTALLATRN REPAMAOORION DESNOICTIoN El WD SEPTIC SYSTEM PERMITTED IF PUPM SEWER IS AVAILABLE WRHIN 200 FEET OF BUILD1NGLI PERC TESThI 1 1 HOW MANY ApAwtlwl� INSTALLATION WILL SENT: FESMOCE 91 COMMMCML d OTHER 13 NUMBER OF LRANO UNITS:-,W NUMSEI OF BEDROOMS: 3 NUMM OF IBLFLOVM& CHARACTER OF BOIL TO A DEPTH OFF�SFEET: 4.0rl j PRlSVMP SOLL CHARER,L'ACTA1=rf{ wATD1 TABLE DEPTH a� SEFTIC TMIKIOREASE TRAP ®TYPIMIFG / tl/L __ CAPACITY NO.COMPAIirMENTS +� PKO TREATMENT MART❑ DISTAME TO NIERMT: FOLAiDATION"n PROPMRY UNE--; . LIFT STATION❑ SIE TYPE OF PUMP SAND OL SEPARATOR¢NCLOSED SYSTEM) (+ t LEACHING LINE NO.k LENGTH OF LINES INOT/ltJCs TO NEALSST:YV9i_Z&.L_FOUNDATION�I _HiOPERTY IDiE,�� WLT01 BED CJ WIDTH LETIGrM DEPTH DISTANCE TO NEAREST:WELL FOUNDATMN PROPERTY LIE e MOUNDED f]WWDFII LENGTH DEPTH DISTANCE TD NEMEST:WELL FOUNDATION PROPERTY LINE IIEFPA71E 1776 I9DEPTH 't]."i 612E `I HUAA$flRaBTANCE TO NEAREST:WEII }40� FOUNDATIDN—;j;j_FIIOPHRY RLE. —S5,_ Sumps SMARTS L3I�I WIDTH tENGTN OFPT11 DISTANCE TO NEAREST:VWDU, FOUNDATION PROPERTY L8IE DWOBAL FORDO LJ WIIITH LEN Srrt DEPRI ORSTMCE TO NEAREST:WELL. FDUMIATION PROPERTY LRE I HEREBY COMFYTHAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIM COUNTY OPDBIAIICES AND STATE LAM AND RULES AND RExiULATims OFTHE SAN JDAQtmCOUNTY.NOMEOWmMORUCENSMAGUalo SNNATINECEAEIREOTNEMUMV M:'ICERTWYTHATINTHEPEAFORMAMMOFTHEWORKfOR%-AWH THIS PERMIT HI ISSUED,I SMALL NOT ELIFLOY ANY PERSON IN SUCH.A MANNER AS TO poDm E SUBJECTTO WOISLAUW'S COMP NSAT10N LAWS OF CALFORN L' CONTRACTOR'S HIRING OR n SUB•CONTRAC'TWO(IMMATURE CERTIFIES THE FOILDYVMN3:'I CERTIFY THAT IN THE PFAFOFIMANCE OF THE WORE.FOR WHICH THIS PEVIIAT tS ISSUED,I SMALL EMPLOY PERSONS SUBJECT TO WORCMAMS COMPENSA ul OF A.'THE APPLICANT MUTT CALL SL)IOW III ADVANCE FOR ALL MINAW pf4PBC710N1s. COMPLETE DRAWMK3 BLi91. /� �7 I SIGNED][ \ TRLE: 6� DATE: WET PLAN WAIN TO SCALE]SCALE 'm i I.NAMES Of STREETS OR ROADS NEAREST TO OR BOUNDBAL THE PROPERTY. A,LOCATION OF MOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSEII 2.OUTLINE OF THE PROPERTY,W"DIMENSIONS AND NORTH D6IECTLDN. DWANBIOM OF$MADE DISPOSAL SYSFHIS. 3.DIMENSIONED OUTLINES AND LOCATION OF ALL DUSTING AND PROPOS STALPCTLIES, G.LOCATRR OF WELLS WITHIN PROM OF ONE HUNDRED PARTY Fr.ON INCLUDING COVERED AREAS SUCH AS PATIOS.DRYEWAYS,ANO WALLS. TIE PROPERTY OR ADJOMMO PNDPERTY. _ AAAA. ..._..>.. v........., .. ... :-. 7 .......•� - - - I�..J LZ. l� „. ---.�. .............- -. � I ...' �V � rt _ ,.. `...,,...�T ..:. AAAA:....... _AAAA ,, AAAA ... . : ( : - - k L 1 - j -- _ h y - q -. �.... � �... r - AAAA. } � `� � ... ..,.,..... AAAA_ •- ..... "'T ., . ,AAAA.. - :: �. a #Y _.+a� 4 AAAA 9 J h '/ SLH �e/ AAAA. ...� -- - . wry �v,v �; ` �' ... AAAA. ._AAAA _ �....�_.. ..i. .. ... ........ . FOR IImAITTMEItT USE aMir AAPPP�IKAT`IONlACCEPTEU BY DATE- ✓ ARE. 'TAta(.IAF pR glptp BtSPEG'TTDN BY DATE�t —INSPECTION BY DATE 17 ADOIT� R)kALCOMMENTS: ACCOUNNNa ONLY: ALOE FACar FE coos FEE INFO AMOUNT ROMTrEll 47ECITI ASH REC9YEO BY DATE LIT U F®wOT NUAatN O/VOlCE/ J P:) tab 7 b I f /