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'I SAN IOAOUIN COUNTY PUBLIC REArmEiI910ES ,1 ENVIRONMENTAL HEALTH UIl H P.O.BOX 988,904 EASY WEBER AAVENLIF,STOCKTON.CA 95201388 12091469-3420 ) .r NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED P ICBmphh iR TripBeetal APPLICATION 1B HEREBY MAGE T THE SAN IOAOWN COUNTY FOR A PEFUrr TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRBED.THIS APPLJCATION IS MADE IN COMPLIANCE WRH SAN JOAOUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9- O.3 AN THE STANPAROSyF�AN JOA((O��U[(I/N�(q/pLINTY PUBLIC HEALTH�6EIRV-ICES,ENVIRONMENTAL HEALTH DIVISION. A f JOB ADPFiFSeAR APf1R /�'" hfViiL/lJ' •-__ Iq�CITY �{•//j�L�c �y/J LOT S12f • S ADDRESS^ _PHONE9�_ a �F OVYNER'8 NAME �"L• c/�• � •��' /7� -y�� `/ CONTRACTOR y �C� AODRE661Z� [,/(A.L/AL��' �PHONE��j�` 3 E BUB CONTRACTOR ADDRESS uCN PHONE l TYPE OF IFFT1C WORK: NEW INSTALLATION REPAIRfA0O1T10N DESTRUCTION CI IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IB AY LE WITHSN 200 FEET OF euiLDINGJ PE9RC TEBTI.1 I 1 HOW MANY APPllostlon f INSTALLATION WILL SERVE' RESIDENCE ......Al❑ OTHER❑ L !L { / NUMBER OF 6 ROOMS: a MUMMER OF EMPLOYEES: }} NUMBER OF V WN4 UNITS: 1 /� WATER TABLE DEPTH 7D !� d CH R OF SOIL TO A DEPTH OF 3 FEE'[: c , ISVMP sOR CHARACTER -A ,HC KlORE48E TRA! ❑TYPE/MFO CAPAC IPU C�YNO.COMPARTMENTS,r�2, - PKO TREATMENT PLANT❑ DISTANCE TO NFJB1FSt: _F i FOUNDATION IO _ PROPERTY LINE UFT STATION❑. SVu TYPE OF PUMP' SAND OIL SEPARM1TOR(ENCLOSED SYSTEMI LEACHING LINE NO,AlE1VOTH OF UNEB PT^ 0' F.'WS' DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY NNE' w FILTER BID Q MOTH LENGTH DEPTH DISTANCE TO NEAREST:YVELL FOUNDATION PROPERTY URE - DEPTH y❑p WIDTH LENGTH DEPTH +� DISTANCE TO NEAREST:WELL (r FOUNDATION PROPERTY LINE L F 6FJ7AOF 1'176 /s+DEPTH _.S! SIZE 3(P ii Nl1MSER 0` DISTANCE TO NEAREST:WELD 'I'�"'FOUNDATION CPS i PROPERTY LINE Irl SUMPS f ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL fOUNDATION PROPERTY LINE DISPOSAL PONOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTYUNE 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOM WILL SE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RILES AND REGULATIONS OF THE BAN JOAGOINCOUNTY.HOME ROR ICENSLD AGENT'S SIGNATuRr CERTRFIES THE FOLLOWING:'I CERTIFYTHAT M THE PERFORMANCE OF THEWORK FORWHRCH THIS Ia 1 UED SH EMPLAY ANY PER IN mICH A MANNER AS TO BECOME SUBJECT TO WGIKMAN'S COMPENSATION LAWS OF CALIFORNIA.'CONTRACTOR'S HIRING OR TO C. RACTIN6 GNA R EB THE FOLLO '1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO ,,�j WOPK AN'S COMP r SAT( 9 O CAU CANT MUST CALL 24 HOURS IN ADVANCE FOA ALL REQUIRED INSPECTIONS' COMPLETE DRAWING BELOW.. f:�7 Ly�-� SIGNE A TILE: ` DATE: ,Z / ^5 7 NPLOT PLAN[DRAW TO SCALE)SCALE I- { T-NAMES OF STREETS O A FAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2.OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. J, DIMENSIONED OUTLIIES AND LOCATION OF ALL EXISTING AND PROPOSED STRIN:TUNEB, 6.LOCATION DF WELLS WITHIN RADNS OF ONE HUNDRED FIFTY Fr.ON RKLUDING COVERED AREAS SUCH AS PATLOS,DRIVEWAYS,AND WALKS- THE PROPERTY OR ADJOINING PROPERTY. ., .............C .. ... 7 ..-.- l.cygt-{... ..... ..r. ... ... ...... e .... . . O.�F .�.... .,.. ...v.. . A �i $1997 . ..... ... ES'ARI JURL7UtN Ct7UNTY`' .:,.,,,, .. . ..... .. 8 t.14 .... <_. .....PUE1LlC HEALTH S�RV,IG� EPIVIRONMENTALHEALTHDIVI-. - R .i__ o. .... ... w k Y :..... .... 4 FOR DEPARTMENT USE ONLY _ 7 APPLICATION ACCEPTED BY I DATE: '� • AREA 1 TANK,PFT OR SUMP INSPEC11ON BY DATE I I FINAL INSPECTION BY DATE E ! ADDITIONAL COMMENTS: ACCOUNTING ONLY: AID# FACT S FE CODE FEE INFO AMOUNT IRETAI ITm CHEC ICASH REC13VED BY DATE SR I PERMIT NUMBER INVOICE FL} Pub.Health Sew,-EnvirG.174(3M)