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ENVIRONMENTAL HEALTH OMSION
<br /> P.O.BOX 388,445 N.SAN JOAQUIN ST.,STOCKTON, CA 86201'0391 r i
<br /> .(209J 489.3420
<br /> O •A� 'AB AMI to �;� ��Kl�at
<br /> . T-YEAR fAOM MAIM Yq c
<br /> {ContPbu M Trfplkstsi '�� 'InJF����?',
<br /> 'P'nllCatlon to hereby mndn to the Sen Joequin'County fora permit to oonatruct end/a,' Instrll the vork,drscribed.' This apptleattan
<br /> awdo In cowl lance with son Jaaquin Canty Develol;ment-Title,-ChePter 4-1118.3 I:nd the St6rtderda of Sen Jo
<br /> services, Environmental Neatth Divfaion. aquin County Pubtie Health st iv k ;:
<br /> Jit, fddress!or APNN . j 4 r
<br /> C1[y r_ Lot 5iis
<br /> Owner's Mane I
<br /> ContractorAddrrss 1 Phane1 i
<br /> _ } [ la��q�l€cr .!305'''1Phone
<br /> 5-w, Cortractor
<br /> Address. nrL€cNT �Phon ��
<br /> TYPE OF gEPT1C WRAK: NEW INSTALLATION f I REPAIRIADDITtONX OEaTAUCTION i( �_PERC TEgT
<br /> ;-,! SEPTI[ SYSTEM pESt]iSTTED lF PUKIC SEWER IS AYAILASLE W:TI,!N 200 FEET OF BUILDING.) i.)ff Now
<br /> 1+.rallati0n will serve: Realdence�•� Lomnercial ?that''. total Use APplka[aar
<br /> w: J,er of livinq unitsiL Nualber of bedrooms= NwmWr of wptoyesss
<br /> _
<br /> eh,r■rtar.of ■o!l to a depth of 3 ierts ,r' it/Surp'So€I'Ch0ractor; "Water 7abie Depth°
<br /> s[^Tic7ANKi0R&pETRAA'" () Type/ltiyJ '°• Capacity No eomgarletwtls �' iJ&4" i '
<br /> P90 TREA UENT PLANT, ! ) Oistance'to nearest + 'Wet[, •—• i .i wr a"
<br /> . Foundetion �.- Property
<br /> LIFT STATIONO,'Size Type of itSend 01t Serotor els ` +
<br /> Pe C losed system) r �y ety SCK
<br /> .'+cHIIiO LINE ' Na, a length of tinea_ yds ,•— Distance to clearest: wet 6/?'�`Found it i property Litvtlrf
<br /> i Es SED (] Width ' LengthDepth " Welt
<br /> Foundation Property Line` s
<br /> a;rWDEO () width Length Depth n �� Well Fotirafet€on Property Llrte
<br /> sf:PAGE PITS , E] Depth'.. Site Ktam6er n n
<br /> Well. T-foundation Pr rt A
<br /> s11fFPS - :() Width Lang Depth
<br /> Y lifle_�_�i
<br /> p Well` Fou�detfon� ia� a {
<br /> 915PDSAIPDNDR ',E) ktdth le f -� •A �ty Llnr��� x i
<br /> V^�th %Depth``` _ � Wali Fourdationt3e!('•��My
<br /> q, i rr rF' r I,, c.rl,s,.r
<br /> �eraby certify that I have grape red lhis:apCl icetion ani that the work wit 1.be done it accordance wi o ig�. �`'t "` , s,r,1, •�
<br /> ,�qw?Bptatcy ord€t,er,ctFy� ,1
<br /> Stnte Lawa,'and Rules end Re4u!etions of the Sen Joequin County. u'xoo owner or licensed aBent'a signature cerkY s the fallowf ,4
<br /> cr.rtify.0at',.in;the per.formanco,of tho:work.for:which'thls permit,ls:issued, I:'shall
<br /> not M fP+CN,f!rr iq�sych a wriirytr 1
<br /> + ccnr_ subject.to'workmt'n-A c.vp,tnsatian.laks of`Lalffornie."-Contractor's hiring or subwtl✓1 rr'�k� a afi�f17i4 �ertiffeKJth
<br /> wrrg: "[.certify that in the'performancs"of tha work-for which this permit is Issued,..fEtpp�r oy.p� s�Z"4ccu"io�km�rt�a s
<br /> T�„xetiw laxa'of,Cat ifornia ” ICS°P� f'rlw�r r tY, $N"ter'
<br /> Te.•: lit - 'r;r '. y.. L NDfVIaf iu ,; n s F^i,.
<br /> !P sat reLrl Bail 2R heat+Iq aQvsata for aN ragNrrs�iaapw[br C tete drawing below.
<br /> 5igrcd X
<br /> Title rs Data �;:2ww
<br /> PL OT,PLAN,(Draw,to Scale).Scele 'n.to
<br /> I vaaros of streets or,voids naarrit to or,bo+axl3,_°the proper
<br /> Ar =� ixTa
<br /> P Y 4 Locat€on o};house sewage di sliosalrsystaasorq��yr " �3T tr{�?'
<br /> rs:,tline of'the property, with',dlmer,sioris-end North.'dfrection ,�,
<br /> pEmensiora; outlines and'location of o(l'cKistii ;and pro
<br /> sed proposed expensiart of',savege.dfspose[reyitagr �
<br /> 3, P po i Location of walls within radtus,of 158 ft on �' `
<br /> trructures }incllydlrtsr covered arses such es patios, dr veweys the property or adjoining property t(,
<br /> enc walk x4
<br /> k Y ; L G r .•�--.: « 4 4v,.f r t b w f-,p: 'is.>f ?v�'7yy+{3�(F�tt� i
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<br /> I!' 71 -} F fs 1 facer^h
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<br /> FOR DEPARTMENT USE ONLY
<br /> 14{u,�1-!#d� .'k+�,"'tat
<br /> Af'pi ir>.tior, Aye apt ed by Date-
<br /> Date
<br /> ate ~
<br /> T c:�t, aft ar,Surg inspection by_
<br /> - Dete_. / / ,Fillet tnepection b - r
<br /> Det ti
<br /> F•Y - I:;nu4 Commonttr•
<br /> '� t,'nuaTINO DifLY: ._. - AIDM - FACq'
<br /> r Cy
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<br /> 11I CODE AEE INFO AMOUiiT REMITTER HECK CAg1I RECE E6 BTS... DATE SR€PERMIT NUMBER 'jMypf;E/ "�"• J°'fir �F ,;,,., r",+,
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<br /> 1141
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