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I AN JOAQUIN COUNTY PUBLIC HEALTH SERVICG+ ENVIRONMENTAL HEALTH DIVISION tt 11 111 p,0. BOX 988, 3" EAST WEBER•AVENUE,STOCKTON,CA 95201388 ( (209) 468.3420 NON-REEUNIIABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED ICompists in Trlplkstsl ATKT 18 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IB MADE 1N COMPLIANCE WTiH SAN JOAGUIN C UNEP DEVELOPMENT rr TIT LE,CHAPTER 9-111/0..f3 AND T14E STANDARDS OF BAN JOAAGGUUIIN COUNTY PUBLIC HEAL TH.SERVVII/CES•ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESSIOR APN/ ldr �� ./ - �" `� -��e CITY ! 'rs'Ui� LOT eIZZ/ f OWNER'S NAME �G� �W 6'� Abtl11E88 PHONE cONTIV1CTOR n, [. ADDREss lri F'C.�sHt�l�./t/ Ca"4' L1CI � G'?S" RHONE - - $^3 y3 SUB CONTRACTOR ADDRESS LIC# RHONE } TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRIADDITION DESTRUCTION D INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUIL NO.) PEtC TEST(@)E I HOW MANY Appllmdon 0 INSTALLATION WILL SERVE: RESIDENLE COMMERCIAL ❑ OTHER ❑ NUMBER OF LIVING UNITS: / Num-at OF BEDROOM$: NUMBER OF EMPLOYEES: CHARACTER OF 6OIL TO A DEPTH OF 3 FEET:// •d+� _'�- PITISUMP SOtI CHARACTER WATER TABLE DEPTH SEPTIC TANKIOREASE TRAP. ❑TYPEIMFG CAPACITY NO.COMPARTMENTS PKa TREATMENT PLANT 0 DISTANCE TO NEAREST: WELL FOUNOATION PROPERTY LINE LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) JJ LEACHNa LINE NO.Q LENGTH OF LINES /- Z /� le DISTANCE TO NEAREST:WELL C'l r • FOUNDATION q0 PROPERTY LINE J� , FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL. FOUNDATION PROPERTY LINE SEEPAGE q7d P DEPTH r 812E 3 1w I NUMBER -3 DISTANCE TO NEAREST:WELL O L'I FOUNDATIONyn + PROPERTY LINE LLI r r� BUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISPOSAL PONDS ©WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE i 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES i AND REGULATIONS OF THE SAN JOAQUIN COUNTY,HOME OWNER OR LICE AGE%IO SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT M THE PERFORMANCE OF THE WORK FOR WHICH I THIS PERMIT 18 ISSUED.1 SHALL NOT EMPLOY ANY PI N IN SUCH A M NNE AB TO'ECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUe-CONT BIG CERTIFIES OWING:'I CERTIFY T AT IN HE PERFORMANCE OF THE WORK FOR NRi1CH THIS PERMIT IB IBt1UEQ,1 SHALL EMPLOY PERSONS SUBJECT TO WOIKM 'S COM N ATION OF NIA. THE APPLICANT UST CA 24 HOURS IN ADVANCE FOR ALL REGUIRED INSPECTIONS, COMPLETE DRAWING BELOW. SIGNED X TITLE,. ___ DAVE: z PLOT PLAN(DRAW TO SCALE)SCALE 'to k 1. NAMES OF STREETS OR ROADS NEA OR BOUNDING THE PRDPERTY. 4, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS.AND WALKS. THE PROPERI V OR ADJOINING PROPERTY. .. 'r - ... - -. ,t, p, _ .. y 1 . .. --IIT�i IAA.. - �t �E LL�y ew- ...... iy ref : . ...... . 7 r .�y L - ..-.. .. .. -. ... . .. - � �. .... --�w+ 'POR'DEPARTMENr tlsE-nNlr=...�—�. --w--••-,�„�-:.�r,�=--=- - _.. .. 1 APPLICATION ACCEPTED BY •7/� DATE: `�/' AJ}REA: �jL 2 TANK,eP1T OR BUMP INSPECTION BY DATE 1.-7.7 FINAL IINNSPECTION BYAor TE ADDITIONAL ADDITIIO/NAL COMMENTS: <'� .s 'µ`• t�I Z� / . ACCOUNTING ONLY: AID# FACT PE CODE FEE INFO AMOUNT REMITTED CMEC"ICASH RECEIVED BY DATE 8R I PERMIT NUMBER INVOICE 0 r Pub.Health Sam.-EnWro.174(3196)