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rcK-II. •. �. 7 1 U✓ rlli _ SAN JOAOSCOUNTY PUBLIC HEALTH SERVICES ENS; 1MENTAL HEALTH DIVISION J P.O.BOX 388,904 EAST WEEIMMENUE,STOCKTON,CA 95201-SM 12Q9)460-3420 fP 1 1 NUM REFUNDABLE PERMIT EXPIRFS I YEAR FRUM DATE ISSUER COPY # ICampIH{M TlipEte{t4I APPLICA710H IS HEREBY MADE To THE SAN JOAOUSN COUNTY FOR A PERMIT TO CONSTRUCT ANDROR INSTALL THE WORK DESCRIBED.THIS APPIICAMN IB MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION- JOS ADDREBSIOR APHI CITY LOT SIZE a✓uC 41� OWNER'S NAME ADDRESS PHONE S + CONTRACTOR —ADDRESS 17 -r � ' ucf�/�f92 s PHH,,R9f $US CONTRACTOR ADDRESS l7C! PHONE ]fpm .TYPE OF SEPTIC WORK: NEW VISTALLATIDN REPNR/ADDITION❑'- DESTRUCTION❑ V + !BW SEPTIC SYSTEM PERMITTED IF PUBLIC M%"IS AVAILABLE WITHIN 200 FEET of BU[LDINGJ PERC TEiTIO I I HOW MANY f�I ,y// APPBoetlan• INSTALLATION WILL SERVE; CJ RESIDENCE COMMERCIAL ElOTHER 13 NUMBER OF IIVINO UNITS:NUMSSR OF/BYE/PjgODMf:_�y NUMBbI OF EMPLOYERS; T CHARACTER OF SOI.TO A DEPTH OF FET�M_ �GArI RT)S.-SOIL CHARNCTIETRY /�n WATER TARLE DEPTH SEPTIC TANKImFASE TRAP I Cyc, I,?pQ �� 00.COMPARTMENTS 7� PKG TREATMENT PLANT T..1 al{TANCE TO NEAREST: WELL FOUNDATION PRGF(RIY UNE TTT++++++ LIFT STATION❑ SIZE TYPE"'.PyuMA `/!'/�A sAHa OIL SEPARATOR[ENCLOSED BYSTEMI LEACFNNO UNE NO,aLFllGTN OF LINER'_".J'... TV ..-ANCE TO NEAREST:WELL –Z,1]2_•FOVNDATKIN �RIOPERTY L. �O` 1 FILTER BED ❑WIDTH LENGTH DEPTH D18TANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE .�..s FAOLDIDED ❑WIDTH LENGTH---- �DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE SEWAGE HTS DEPTH SIZE—,Xd NUMBER_DISTANCE TO NEAREST:WELL IS"L7 FOUNDATION �r-PROPERTY LINE �L} -UMPf VMOTH LENIITH DEPTH DISTANCE TO NEAREST:WELL .FOUNDATION POPEITTY UNE DISPOSAL POND{ Q WIDTH LENOTH DEFRH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I NAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAOU COUNTY ORDINANCE$AND STATE LAWS,AND RULES AND RLamknoHBOF THE BAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFTES THE POLLoMHO:4 CERTDYTHAT FNTHE PERFORMANCE OF THE WOFK FOR WHICH TIES PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AB TO BECOME SUBJECT TO WOFKMAN'S COMPENSATION LAW{OF CALIFORNIA.•CONTRACTOR'S HIRING OR �e�+ SUB{ON IIACTING ING"ATURE CERTIFIES THE FOLLOWING:I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FoR WMCH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO eE WOiKMAN'S:C=W8 OF C7ANT MUST CALL 24 HOUR{IN ADVANCE FOR ALL REQUIRED INS NS. COMPLETE DRAWING BELOW. /y7 SIGNED% TITLE:6 DATE: PLOT PLA94 MAW TO SCALEI SCALE 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 1e4.L.00ATFON OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED Y.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. i♦♦ 3.DIMENSIONED OUTLINER AND LOCATION OF ALL EXISTING AND PROPOSEO STRUCTURES, S,LoCATioN OF WELLS 1MTNIN RADIUS OF ONE HUNDRED FIFTY FT.ON '.wy FNCLUOING COVERED AREAS SUCH AB PATIOS,ORNEWAYS,AND WAUKS. THE PROPERTY OR ADJOINING PROPERTY, 7 ...... o..... _ - ;... .. / is ic3G �T — .... . ...:.! o( ... ... . .......... ... ....... .. ...... ..... �.. . k`+JOAQWN COW .., ..,c......'-- -- ......... ,......i.... s..- - - ..:... .,'. .. ......i _..... ..... ......_ FNVIkrIMLiFnme� ..�. ... ......_._ F I } i I