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# SAN JOAaum COUNTY PUBLIC NEP.JP% SEIIVICES �� ENVIRONMENTAL HEALTH DI, A P.O,BOX 388,304 EAST WEBMAVENUE,STOCKTON.CA 95201388 I2091 461.3410 2 3ROA•REFURDABLE PERMIT EXPIRES YEAR FROM DATE ISSUED Y IDomn�e in Tris l.al APPLICATION 19 HFRESY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDMA INSTALL THE WORK DESCRIBED.THIS AP UCATION IS MADE IN COMPLIANCE g AN JOAQUIN COUNTY DEVELOPMENT TIT-LT CHAPTER 0-17 10,3 AND THE STANDARDS OF SAN JOAQUIN CO NTY PUBLIC HEALTH gERVICE6,ENVIRONMENTAL HIO HEALTH DIWSN. WITIS `r Joe ADDREGSMRA //�!• �i'�Lfw S@ Lues ''1 '� � CITY G7 OWNER'S NAME W a -LOT giYE '� t OW y ADDRESS 19 3 �,Te.'r�{ ! PHONE W-a& z CONTRACTOR ,,4 = (� DRIES Z/ � � �^�C. 5/ +- V zzr� 4 ..- PHONE C SUS CONTRACTOR AQpRpB3 TYPE OF SEPT] uce PHONE C WOgI[; NEW INSTALLATION REPNRIADgT1oN❑ bE.TRUCiTON❑ IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVA LABLE WITHIN Zap FEET OF BUILDINO.I �I � FIRE TEfThI It HOW MANY w i INSTALLATION LTf14 TERVE; gESfbENCF I AppBentleR 7 ❑ OTHER a/ V- ++ COMMERCIAL [] NUMBER OF LNIN4 UNITE: l NUMBER OF.mA OMS; 1 NUMBDi OF 6YIPLOYEE.; �+3 CH OF—TO A DEPTH OF 3 FEET: PTT-UMP BOIL CHARAL IR WATER TABLE uEPTH ILpO rt i CT EASE TRAP ❑TYPFjT,fFO / ^�� T-� - cAPACTTY 'ZP.A� /O 4 ND.COMPARTMFNfS, 4-1 PKO TREATMENT PLANT Q DI.TANCE TO NEAREST: WELL//Ad3 I y �.-- FOUNDATION PROPERTY LINE Z� � Fl IJFTSTATION❑` SSI FTYPE OF PUMP SAND OIL SEPARATOR}ENCLOIEO SYSTEMI LEACHIHO LINE NO.8 LENGTH OF LINES _ r `2e - DISTANCE TO NEAREST:WELL 3�0, ��T f pITETi SED FOUNDATION PROPERTY LINE (.LEJLYI WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL_FOUNDATION PROPERTY LINE ❑ OTM LENGTH DEPTH DISTANCE TO NEAREST:WELL SEEPAGE PITS yT-.�,.Pp� ^�� r FOUNDATION PROPERTY LINE H ^L_ DISTANCE TO NEARE.T:1111113g `� f �- .UMF/ FOUNDATION_TQ ,PRDPERiy UNE Cg6 ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL (1 DMPO.AL PONDS FOUNDATION PROPERTY UNE ❑WIDTH LENOTH DEPTH DfSTANCETONEAFTECT:WELL FOUNDATpN PRpPERTy LINE IFY 1 HERESY REGULATIONS THAT 1 HAVE PREPARED THIS Y.140 gTTQ AND THAT THE WORK V,ILL SE DONE IN ACCORDANCE WITH SqN-IPA°UIN COUNTY ORpfNANCEe AND STATE LAW B,AND RULES ANp REOULATR)NS bFTHE SAN JOAQUIN COUNTY.HOMED RORIaCIENSED AOENT'g Bu3NATURE CERTIFlESTHEFOLLOWINO:'ICERTIFYTHATINTHE PERFORMANCE OFTHEWgp(AND RUES THIS O"" Ri ISSUED,I SHALL DY ANY FTR$O IN CH A MANNER AS TO BECOME SUBJECT Tq WOPKMAN'e COMpENSATpN U1W6 OF CAUFOgNfA.•CONTRACTOR'S MIRING OR rr SUB CO IND 61 TUPE RTIFIE THE FOLLQWI :-I C FY THAT IN PERFORMANCE DF THE WO PI(FOR WHICH TMS pERM7 IS ISSUED,1 BHAL,L EMPLOY PERSONS SVBJECT TO WO ANT C SAT N OFC LI RNIA.' CALL 21 HOURS IN ADVANCE FOR ALL RE m INFPECTION., COMPLETE DRAWING BELOW. + SIGNED /p /Q .yam I TITLE: GATE- V / 7 1 PLOT R-AFI IDFWW i0 SCALE)6CA[E -}e 1.NAMES OF STREETS OR ROADS NEAREST TD OR SOUNDING THE PROPERTY. 4. I 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. LOCATION Of HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED '� L 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EAISTING AND PROPOSED STRuCTUREe, - EXPANSION OF SEWAGE DFSp0M SYSTEMS. iMLVDINO COVERED AREAS SUCH AS PATIOS DRIVEWAYS AND WALKS -9,LOCATION OF WELLS HUNDRED FIFTY FT.ON .... -- ... .. .....;.. ....... - .... THE PROPERTY OR ADJOINING PROPERTY. O� y .... T . . �o :L. Q�.L; ,.. . Nc.�ls� i ....:... ... .... ... - ' .. ....[ ILL ---..... �7oy .. H v FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY ��//////''''''��,��,m�iT AREA: 1 EDYOR SUMP INSPECTION BY DAT FfNAL INSPECTION BY ('� /�. `T DATE__ ,J , . ADDITIONAL COMMENTS: �S � .,.I Or., ACCOUNTING ONLY: AID,P FAG PE CODE FFE INFO AMOUNT RMWITED CIIEC RIC ASH• RECEIVE°BY DATE SR I PERMIT NUMBER r� Z 1 f O 2.0 � - -g INVOICE Pub.HeaRh Serv.-Envlro.174(3196) v