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nd + APPLICATIt R. LEOUCD WASTE PERMIT coi SAN-JOAQUIN COUNTY PUBLIC HEALTH SERVICES { ENVIRONMENTAL HEALTH DIVISION P.O.BOX 988,304 EAST WEB>=R AVENUE,G OCKTON,CA 8.5ml X68 I 1209)468.3420 i ` ' I' NDN-AEFUNDAB E PE!MIT EXPIRES 1 YEAR FRom DATE ISSUED IC@mplas In TrlpRe@tBI FAPPLICATION$0 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED,THIS APPLICATION IS MADE N COMPLIANCE WITH SAN IADUIN COUNTY DEVELOPMFHT TITLE,CHAPTER 8.1110AV AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTHr SERVICES,ENVIRONMENTAL HEALTH DIVISION, IB ADORE881oR API/ `c+p�C - CITY `+I LOT /� f 97 OWNER'S NAME 1'► 1 ADORESH RHONE_ SLIC# PHOrNTRACTOA,__ e cGNTRAeTORADOR,Eee_ _�01C. �S b uc,�FrwNE -?Y) TYPE OF SEPTIC WORK: NEW NSTALLATIO REPAIIVADDITON 13 DESTRUCTION 1� B EPTIC SYSTEM PERIRIT'IEb IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.) - PGRC TESrW f I NOW MANY APPIBSSm# FSTALLAMN WILL AWVF, RESIDENCE�oMMERCuL,IJ OTHER 13 NUMBER OF IIVINO UMYs: NUMSFIL OF BEDROOMS: NISMSER OF EMPLOYEES! rr CHARACTER OF SOK TO A DEPTH OF y33 FE.1�ry_PITISUMP SOIL CHARACTER: WATER TABLE DEPTH Q RTIC TANIUGREILBE TRA► Ey,I'lYPE1/IAFO_�-L Cn-g `c I-e CAPACITY_- I'�}.71 T NO.COMPARTMENTS-.- [G TREATMENT Pwn DISTANCE TO NEAREST: - +DoT FOUNDATION r n 1� PROPERTY IJNE� LFT STATION❑rSIVE TYPE OF RUMP �Y�-�-SAND OIL SEPARATOR(ENCLOSED BYRTEMI--�-� ), '} LEACISNG LINE U-No,S LENGTH OF LINES ` DISTANCE TO NEAREST:WELL Ii FOUNDAT*N ^iCJJ PROPERTY LWE U LTH(SED 13 WIDTH LENGTH OEPTU1 DISTANCE TO NEARESrr WELL FOUNDATION PROPEKTY LINE OUNDED 13 WFDTH i.ENGTH DEPTH +� DISTANCE TO HEANEST:WELL FOUNDATION PROPERTY UNE -EEPAGE PITS C�pEprH '1 C( SLLE�G NUMBER �.7 DISTMICE TO NEAREST:--LL -UNDATJON 41 Or PROPERTY UNE Z�S SLUMPS 13 wTOTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPER,V UNE '•- -N f-WSPOSAL PONDS 11 Wtb* EP LENGTH DTH DISTANCETO NEAREST:WELL FOUNDATION PROPERTY UNE n. ' I11 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATIDN AND THAT THE YYORK WILL BE DONE tR ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAW@,AND RULE! ND R{OUTATONS OF THE BAN JOAQUIN COUNTY.HOME OWNER ORLICENGED AGENT-8 SONATURE CERTNIES THE FOLLOVANG:'I CERTIFY THAT N THE PERFORMANCE OFTHE WORK"WHICH 'THIS PERMIT 18 ISSUED,I SHALL NOT EMPLOY ANY PERSON N SUCH A MANNER AS TO BECOME SVSJECT TO WoWMAH-S COMPENSATION LAWS OF CAUFORMA-" CONTRACTOR'S HNYNO Oil OUR-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO FKMAN'@ COMPENSATION LAWS OF CALIFORNIA.* TUH APPLICANT MUST CALL 24 HOURS N ADVANCE FOR ALL REOUMD INSPECTIONS, COMPLETE DRAWING BELOW. c t,� EIGGED x r' _ TITLE: DATE: PLOT PLANIbRAW TO SCALE(8CAL.E •le NAMES OF STREET8 OR ROADS NEAREST TO OR BOUNDING THE PROPERTY, s.L)CATON OF HOUSE SEWAGE DISPOSAL SYSTEM ON PROPOSED OUTLINE OP THE PROPERTY.WITH DIMENSIONS ANO NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. .OMENBIONED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON GNCLUDING COVERED AREAS SUCH AS PATIO@.DRIVEWAY@,AND WALKS- THE PROPERTY OR AbJONNG PROPERTY. r. -r............. -..r.. .- .. _ F. C. , . .... - .. `.., ' ,s 4_ �. Q. . ..I f � q ... � .. >. .. .. ..11r y .. ¢ . . ... � fi :. .. . . 11 .. .. .Q. � a L. r=FL N S a .,,... A. JIHO�fivlLftTAI . H X14, .. S _... FOR DEPARTMENT Use ONLY 1f ' Al..ACCEPTED BY DATE: F AREA:�_f NEP[CTION BY DE�r I f�19 fn FINAL N9 110N BV PATE f tl rid d rLfi 81 DDITX/N MENT9: � ACCOUNTING ONLY: PE CO-DQE' FEE INFO AMOUNT REMITTFD CHEC /CASH RECEIVED BY DATE M 1 P@WtlT NUMBER INVOIOE z, Toho R o3 (00