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JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> � <br /> ENVIRONMENTAL HEALTH DIVISION �. s �a: <br /> P.O. BOX 388,3 EAST WEBER•AVENUE, STOCKTON, CA 95241-988''"s ,. A <br /> (zos) 46e-3420 � ;. .;� .. �[�, er1c, <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IComptats In Triplicate) <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQVIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOftC DESCRIBED, TF118 APPLECA IB IN BAN <br /> JOAQUIN COUNTY DEVELOPMENT TItLE.CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES,ENVIRONM <br /> f1 JOB ADDRESSIOR APN# 7,A6'7 1�!. G���T�1 (� Nye'. cITY �01��.. O. 1jLffO__T slzEp X1.1 .• <br /> i OWNER'S NAME I�ULD`f rT .1-0"T1�1Z noonEt3S 'L0`I ¢--UT.'JNL_ �! PHONE 4(0(4'.--1 4 <br /> CONTRACTOR "-t:D0WAL ,SWOp�T ZNG..__ _ngonM3 4rD45 L�PCN LIC# "IS°I 5°L� PHON 3l-o4Rl <br /> SUB CONTRACTOR AOgRE6S UC# PHONE <br /> I TYPE OF SEPTIC WORK: NEW INSTALLATIONJ9 REPAIRIADDITION ❑ DESTRUCTION❑ <br /> 3 <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER t8 AVAILABLE WITHIN 200 FEET OF BUILDING.1 PERC TESTI)I 1 NOW MANY <br /> Appllaa8on II <br /> INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL 19 OTHER ❑ <br /> NUMBER OF UVINO UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES ,r�Z5 <br /> CHARACTER OF SOIL TO A DEPTH OF�33 FEET: C LRY _FITISUMP SOIL CHARACTER: Ir PA - WATER TABLE DEPTH '7451 <br /> 7 <br /> SEPTIC TANKIOREASE TRAP LA9 TYPFjmFo N Ft L CAPACITY 2 000 A Y`D N ND,COMPARTMENTS 4 <br /> PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION S` PROPERTY UNE 100# <br /> UFT STATION© SIZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSEO SYSTEMI <br /> LEACHING UNE 0 NO.8 LENGTH OF LINES 40' DISTANCE TO NEAREST:WELL Gam_FOUNDATION J JZ PROPERTY LINE 2 ' <br /> FILTER SED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERI v UNE <br /> MOUNDED ❑WIDTH LENGTH �CDEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> SEEPAGE PTS ®DEPTH ?-G f 812E ✓# NUMBER ,-3—DISTANCE TO NEAREST:WELLCI+,V FOUNDATION—/ SZ-# PROPERTY UNE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> DISPOSAL PONDS 13 MDT"--.. LENGTH OEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS AM'LICATION AND THAT THE WORK WILL RE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND IWLES <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AOENT'S BIONATURE CERTIFIER THE FOLLOWING:'1 CERTIFYTHAT INTHE PERFORMANCE OF THF WORK FOR WHICH <br /> THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUFORNIA,' CONTRACTOR'S HIRING OR <br /> SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18ISOM.I SHALL EMPLOY PERSONS OU13JECT TO <br /> WORKMAN'S COMPENSATION LAWS OF�CAUFO�RNIIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. <br /> SIGNED X ' `�' '�" ��C/F�V _ TITLE: T0 DATE: o-" ZL I, <br /> PLOT PLAN IDRAW TO SCALER SCALE 'to <br /> 1. NAMES OF STREETS OR ROAD8 NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITMN RADIU8 OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJ09MNO PROPERTY. <br /> .. .. .. <br /> .. <br /> ....,...„...,:.. .. <br /> P'44`I <br /> '� ' . s <br /> - ; <br /> n1 !fU <br /> :..... _ .. .......... . <br /> :.. .... <br /> ` .. <br /> ... — <br /> f.la .. . ... <br /> ..... ..... ..:...... <br /> .... .. ., ..., ..... __ .. <br /> - - ' .. <br /> .... ....:.... .,..,... .... .. ....-,. ...,...-. ..... .. <br /> .. .. .. <br /> i v f <br /> : <br /> ...... .... - .... - <br /> '.. ... .. ...y .:.....:......:.....: <br /> ..... <br /> .. <br /> ;. . <br /> ... , -1+rwras�!,ius!�1�Igi�r_wa, <br /> :. s. .. <br /> :....; <br /> ;....... <br /> m <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY r1 DATE: ra �Z REAS <br /> �R BUMP INSPECTI01�.ljBY ,�•� ;TIS-� { 1-DATE !67! FINAL INSPECTION BY DATE , <br /> ADDITIONAL COMMENTS: L� D� f��r I_N 7�-01.LV1 �e (ems b <br /> IF I <br /> ACOOUNTINO ONLY: AID# FAC# <br /> CODt FEE INFO AMOUNT REMITTED HEC CASH RECEIVED BY DATE SR I PERMIT HUM891. 1' -INVOIC[ <br /> 47, 1 <br /> t,- Puts HaNth Serv.-ERYiro.174(3/96) <br /> t <br />