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STE PERMIT /}�-� <br /> APPl.ICATIDH FDR LIliIIID WA D�. <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> {CimpMt6 In HpRaeti} <br /> APPLICATION IS HEREBY MADE TO THE BAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOW DESCRIBED. TWO APPLICATION tBADE bIWf <br /> OMPLIANCE TH SAN <br /> ALTH <br /> OUI <br /> JOAN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOVIH COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENT <br /> G 1 2 r G --" IL-C G LOT SIZE i <br /> JOB ADQREBSIOR AFNr <br /> � ADORES42 C/_ p -,- b <br /> OWNER'S NAME �-+ I <br /> 7 <br /> ?U t1CI <br /> CONTRACTOR. <br /> SV0 CO1dTRACTOR <br /> ADDRESS LICE PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION RFDArWADOLTLON 13 DESTRUCTION[3 <br /> UGO SEPTIC SYSTEM PERMITTED IF PUSLIC SEWER IB AVAILABLE WITHIN 200 FEET OF SU11.000J <br /> PfSiC TE4Th1 l 1 HOW MANY <br /> APPS^/ <br /> INATALLAnON WILL SERVE: RESIDENCE❑ COMMERCIAL _ OTHER❑ <br /> NVMS@1 OF LIVING L►NITi: _ NIJwlIRE1I OP BYIFLGYEIx: �_ ,0cj <br /> PITIGUMP BOIL Cep:.. WATER TABLE DEPT <br /> CHARACTER OF WX TO A MPT H OF 9 FEET: <br /> iEPT1C TANR/(>pIIEASE TRAP ❑7YPFJMFO _— CAPAGLTY !� NO.COMPAIRMEHf�B�,�j� .— <br /> PKO TREATMENT MAW r_] OIsTANCE TO NEAREST: WELL >fC� FOUNDATIONS PROPERTY <br /> UFT STATION 13 611:E_ TYPE OF PUMP SANG OIL SEPARATOR fENCL.OSED SYBTEMI <br /> r� �T f <br /> LEACHING LINE P1 NG.i LENGTH OF LINES-4i. — y� .— <br /> DISTANCE 70 NEAREST:WELLFOUNDATION <br /> PROPERTY LINE >7 <br /> FILTER BED 13VADTH LENGTH :WEL <br /> DEPTH DISTANCE TO NEAREST.' FOUNDATION _ PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH fOEPTH <br /> DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> But HUMBER DISTANCE TO NEAREBTI WELL FOVNV^MN,�•��PROPERTY 1UNE <br /> sEEfAGE LITS ❑DEPTH pfgpERTYLGNE <br /> Smp$ ❑WIDTIH LENGTH DEPTH DISTANCE TO NEAREST:V&tL FOUNDATION <br /> r DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> 1 HEREBY CERTWY THAT f HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND <br /> RULES <br /> AND REGULATIONS OF THE SAN JOAQUIM COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIER THE FOLLOWING:I CERTIFY THAT IN THE PERFORMANCE OF THE WOOR'S HIRING OR <br /> THIS PERMIT IS MOVED.I SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO yyplrUMAN'S COMPENSATION LAWS Of CALIFORNIA.' CONTRACT <br /> W&tONTI A C LNG SIGBNAT RE CES I F CA�THE <br /> FOL " M:THIN 11 THAT IN TW FL1CANT MUST CALL E CERTIFYFOOURS IN ADVANCE FOR ALL REn—NIXED LN �E OF THE WORK FDA VMICH THIS PERAffT'a IFWAHC �SUEDMPLETE DRAWIHOOBELOW-AVEdKWS QCT TO <br /> SIGNED X I TTfLE.,. <br /> PLOT PLAN(DRAW TO SCALES SCALE ' LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> m�-�•�- <br /> 1. NAMES OF STREETS DI <br /> OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.EXPANSION OF SEWAGE DISPOSAL SYSTEMS-2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH L]IRECTIDN. S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON Q <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, THE PROPERTY OR ADJOINING PROPERTY. <br /> IINCLUDING COVERED MEAS SUCH AS PATIOS,DRR1klNAY6,ANO WALILS. ....................:.............. ........... <br /> .. -.. - -- <br /> i J ., <br /> I ' <br /> �. . <br /> `� <br /> 1 f :H <br /> . <br /> ....:. ..:. <br /> �--*- <br /> .. . ... . <br /> ;. ...... .... <br /> c <br /> M F.Nl <br /> ..............d...................L.....<..... <br /> f ..... .. PAY <br /> ... . . <br /> .. S <br /> 1...:. 1. .... <br /> . 19 <br /> .. ..,. ...SAiW..I(3FlCatlllu.0)irllyd7l,.,...... <br />