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SAN J OUIN LINTY PUBLIC HEALTH SERVICES <br /> YIR ?YTAL HEALTH DIVISION <br /> P.Q.BOX 398,9la _.eRER-AVENW,STOCKTON,CA 95201688 [ 1 <br /> {2091 489.3420 <br /> L�Ewy <br /> OA•REFURUARLE PERMIT EXPIRES YEAR ROM CATE ISSUED <br /> Mmup!$u ID TIIPUe■WA ATION MAGE TO THE SAN JDADUN COUMFY FOR A PERMIT TO CONSTRUCT ANDIDR INSTALL THE WORK DESCRIem.THIS/WPLICA7ION M MAGE M COMPLIANCE Wfn1 BAN <br /> �I,QUIN COUNTY DEVELOPMENT TITLE,CHAPTER 8.1110.3 AND THE OF$AN JDAQGIN COUNry P418LLC HEALTH SERVICES. AL HEALTH DIVISION. <br /> Joe ADDReseron AFNf I E CITY , r a <br /> LOT$12FL <br /> 11R'^;VNEIi'$NAME � ... i' Lt CSO ADORE88 FF RiONE_p/ /`�',3OD <br /> ] iNFMCTOn � y �'� ADDRESS 1 ^LICE 6Q/yw PHONE ! <br /> SIRS CONTRA=OR ADDRESS LICE PHONE <br /> PE OF iFfflC WORE; NEW INSTALLATION❑ R®ANVADd N DESTMIeTION❑ <br /> O SEPTIC BYBTElrI PERMITTED IF FUEL=SEWER IS AVAILABLE WITHIN 200 PEET OF RUILDNOJ POW TEPTIO 1 MOW MANY <br /> —ALLATION 11P1 Appk."-f <br /> Li i6N@ RESIDENCE W, COMM[RCIAL i] OTHER <br /> NUMBER OF LIVING UMTS: NIMMSER OF SEIROOMS: �NUMBER OF EMPLOYEES_ <br /> F-ARACTER <br /> DF SDR TO A-PTH OF 7 FEET; PITISUMP SOIL CHARACTER! WATER TABLE DEPTH <br /> s17C TANE/OREASE TRAF ❑TYPEJMFO CAPACITY NO.COMPARTMENTS <br /> L.R <br /> rAO TREATMENT ANT 13 INSTANCE TO NEIWEST: WELL FOUNDATION PROPERTY LINE <br /> UFT STATION❑ SITE TYPE OF PUMP SAND OIL SEPARATOR{ENCLOSED SYSTEM, <br /> RANO UNE ❑ HO.i LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PIOFE)1TY UNE <br /> DR BED I❑WIDTHLENGTH OEFrP DISTANCE 70 NEAREST:WELL FOUNDATION PROPERTY LINE <br /> 7UNOm U WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOVNDATEIN PROPERTY LINE <br /> SEEPAGE ADEP <br /> TS TH $U3_ NUMBETI_y�DISTANCE 70 NEAREST:LYETLQ�FOUNDATION PROPERTY LINE <br /> SUMPS ❑WIDTH -LENO7H DEPTH DISTANCE TO NEAREST:WELL . FOUNDATION PRDFERTY LINE <br /> EPOSAL PONOS I3 WIDTH LENGTH DEPTH bISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> lETREBY CERTIFY THAT I HAVE <br /> TH <br /> PREPARED THIS APPLICATION AND THAT E WOR(WILL BE DONE N IN <br /> ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,APO AFLUSAND REOULATWNSOFTHE SAN JOAOUN COUNTY.HOMEOVMMORUCENSm AGENT'8810NATUPECERTIRESTHEFOLLOVVRKL:'I CERTIFYTHATLATHEPERFORMANCE OF THE WORK FORWHICH <br /> THIS PERMIT IS ISSUED,I SHALL NOT LMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WOPRMAN S COMPENSATION LAWS OF CALIFORMA.•CONTRACTOR'$HIRIM OR <br /> SUB'CONTRACTINO WaNAYUM CEPITIFIES THE FOLLOW M:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THE$PERMIT to ISSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> rMANETE FOR ALL REQUIRED INSPEC710N8.COMPLDRAWING BELOWE 1L.7 TITLE: (O LL1 A JO— DATE: 99 <br /> PLOT RAN(DRAW TO SCALE)SCALE •m <br /> 3'NAMES OF STREETS OR RoAD3 NEAREST TO OR BOUNDING THE PROPERTY, 4,LOCATIONOF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> UT <br /> }OLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. FJRPAHSION OF SEWAGE DISPOSAL SYSTILMS. <br /> DIMENSIONED OUTLINES AND LOCATION OF ALL E)USTM AND PROPOSED STRUCTURES. S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> —INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WAD(& THE PROPERTY OR ADJOINING PROPERTY. <br /> >.... s�. . <br /> N <br /> .. -- <br /> s�- <br /> l"IIC�.Kirt��, <br /> . .....t <br /> : # <br /> I <br /> { � <br /> .ry. <br /> ,lt1�l',:2 4 1998 <br /> :... . ...... .. . . . . <br /> I Ari J A <br /> IN <br /> a'r�rr <br /> .'......<.. ..... ..<..... ... . ..:._ ..-....n. ..... ..-..- IsIcI <br /> s <br /> :P[JBI:ICI TH;SEFTVECL ' <br /> /�,(J FOR DEPARTMENT USE ONLY <br /> �RICATION ACCEPTED BY W R p DATE, AREA: r 1 <br /> 77 <br /> F OA MP NSPECTION BY DATE I I FINAL INCPECTION BY DATE—�^ <br /> AD,IIXTJI M. / <br /> ACCOUNTING ONLY: AE)f FACT <br /> PE COOP: FEE INFO AMOUNT RSMI{TED CHEC !CASH RECEIVED IT DATE SR I PERMIT NUMBER INVOICE f <br /> 2 i �Q � P �'3D7 4��I�rB 1 •� <br /> Pub.Health Serv.'-EITV$O.174(3196) <br />