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0002q,/ <br /> SAN JDADUIN COUNTY PUBLIC HEAlPEWFIVICES <br /> ENVIRONMENTAL HEALTH DIS N <br />` RO,BOX 388,304 EAST WESERMENUE,STOCKTON,CA 9520/398 <br /> (2091469-3420 <br />+ l <br /> NON-BEFUNDA13LE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 7�'7 (CBmplsh In TripClniel <br /> l APPLICATION IS NEWBY MADE TO THE SAN JOAOUIN COUNTY FOR PFRMIT TO CONSTRUCT AND10R INSTALL THE WOW DESCRIBED.THIS APPLICATION 16 MADE IN COMPLIANCE WITH SAN <br /> JOADUN COUNTY DEVELOPMENT TITLE,CHAPTER 0-1110.3 AND <br /> �THE <br /> r B'TAhoAR/yD�s qF SAN JpA I�Cu 7`NTy RfB EALTH SERVICES.ENVIRONMENTAL HEALTH D1NS10N. Q� <br /> n 2-7 <br /> JOB ADDREGRRHR APNf - LV`Gi'�^G`� ![�QQ(xJ/ /¢ TC �1 .TF/Y �CQ�'�(5 LOT 82E Q�-./Q*"V'• <br /> i OWNER'BNAME --Eesti' �� ADDRESS //D�d �• /�Q'ML^- {�j �- P710NEZ["�37 _JYZ <br /> CONTRACTOR AOOPE6�� CIU14CIp ll �" �"Y LIC/ 2175_ PHONE <br /> 1 <br /> BUB CONTRACTOR 77 ADDRESS LIC/ PHONE <br /> Q TYPE OF SEPTIC WORK: NEW INSTALLATION 9v <br /> REPAIR/ALOITION CI DESTRUCTION❑ <br /> LLL INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 19 AVAILABLE WITHIN 200 FEET OF BUILDING.( .TESTh11 I HOW MANY <br /> �I �My APpraetlen f �� <br /> 1: INSTALLATION MILL SERVE: RESIDENCE Lyl COMMERCIAL❑ OTHER d <br /> M NUIOBER OF LIVING UNITS:(NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: I i1 <br /> OF SDR TOA DEPTH OFT-3 FEET' /fstT PrT/SUMP SOIL.CHARACTER: 6 WATER TABLE DEPTH <br /> EPTIC K/OREA6E TRdp QTYPEASFO L .GG - Pry CAPACRY ��� A"", NO.COMPARTMENTS <br /> PKO TREATMENT PLANT Cl DISTANCE TO NEAREST: WELD T <br /> L� M�,,, �� FOUNDATION S PROPEITtY LINE 100 <br />' r UFF STATION❑ SIZE TYPE OF RUMP SAND OIL sEPARATon(ENCLOSED SYSTEMI <br /> 1I�--, , ^ <br /> F IFAOMXO UNE NO, LENGTH OF LINES r //1 C S D*TANCE TO NEAREST:WELL , FOUNDATION�U PROPERFY UNE <br /> RLTER BED ///❑ 4 WIDTH LENGTH + DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> i MOUNDED ❑WIDTH LENGTH <br /> y��4 DEPTH DISTANCE TO NEAREST:WELL FouNDATION '/ PROPERTY UNE <br /> SEEPAGE RTS (. DEPTH -SIZE_�NUMBrA OZ DISTANCE To NEAREST:WEll �r FOUNDATION TQ _ PROPERTY UNE CQ� <br /> 1 <br /> r BUMPS ❑WIDTH LENGTH DEPTH DISTANCE YD NEAREST:WELL FOUNDATION PROPERTY LINE <br /> DISPOSAL PONDS Ea WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WEU. FOUNDATION PROPERTY UNE <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE NARK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REOULATIONS OF THE SAN JOAGUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIED THE FOLLOWING:"I CERTIFY THAT IN THE PERFORMANCE OF THE WOR(rOR WHICH <br /> I TMS PERMIT ED.1 SHALL HOT EMPLOY ANY PER IN SUCH A MANNER AS TO BECOME SUBJECT TO WOW MAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S WRING OR <br /> SUBCO LTINO GN RE C S THE TOLL :7 CERTIFY THAT 1N THE PERTORh,1AHCE OF 7HE wOFK PoR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SVBIEC7 TO <br /> {- WOIKMj6 CDM S 10 OF ALIFORNI CANT MUST CALL 24 HOURS IN ADVANCE FOR ALL. <br /> B�EOUNtED INSPECTIONS,COMPUTE DRAIMNO SEQIOW.Q <br /> SIGHED X TITLE: DATE: 1-V q7 <br /> PLOT PLAN(DRAW TO SCALL(SCALE-'le , <br /> I 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 3.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. bIMENSIOHED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6.LOCATION OF WELLS VOTHIN RADIUS OF ONE HUNDRED FIFTY rT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS.AND WALKS. THE PROPERTY OR ADJOINING PROPERrY. <br /> J. ......... : <br /> .......... <br /> k ............ ........ _,.E... ....... <br /> ... ....E ....J. . <br /> .... <br /> .............. <br /> ................ <br /> .......... <br /> ... <br /> F.4 <br /> r .... .... ...t..... E_ ...... <br /> - -_ _ ....o. .. . <br /> 1 <br /> A <br /> -" .... .. . .. . ..,o.. ...:. ..-- ..r. ..... <br /> I .-....... - .. <br /> 4 <br /> C_ <br /> F �3.7a9 <br /> FOR bFPARTMFNT USE ONLY <br /> APPLICATION ACCEPTED BY /frL�f�./ _`PATE: �y / AREA:L�J,-"- <br /> Q&.11 SUMP...T(ION�El DATES NS 1 SINAL INSPECTION BV[� ATE.+�!l <br /> 97 ADDITIONAL COMMENTS: YTn ISS ZO �I`/` C 'f� : i "" � 2d - <br /> ACCOVNTM.ONLY: AIDE FACE <br /> PECODEFEF INFO AMOUNT RLTRI('TED H X/ICASH RO:HVPD SY DATE SRI PERMIT NUMBER INVOICEo <br /> Z!I S �v vc 194?* <br /> / •� O <br /> Pub.HBalih Serv.-Enviro:174(3/96) <br /> i <br />