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APPUCATIOR FOR UOUIO WAta PERMIT SAN JOAQUIN COUNTY PUBUC HEALTH ENVIRQ MENTAL HEALTH DIVISIONRVICBS R CEI ED 304 EAST WEBER AVENUE,STOCKTON,CA 95202 } (209)ase-U20 OCT - ¢ 2000 NOWREFUNOARLE PERMIT EXPIRES I PEAR FROM PATE 1229ED SAN JOAOUIN COUNTY d lC mplate In Trtplhatal ENu�u1B�t�lc-_Hfalt�SER APPt1CAma"H IIEftmv MACE TO THE WM JOAMNN COUNTY FORA PERMIT TO CoNSlmrCt ANMR INCFALL TWWOW DESCRISFO.THIS APFUCATION /.pFI A\R7H�AN 11 JOAgRN CotwTy DEvIvLoPMENF TM&CIRAMER 9-t T10.9 AND THE OTTAAN[DAANCa of&AAm joAWm COUNTY KrKM NEALTH OERV10Ea.EM MUNIENTAL NFJILTH mVIi Ir ' JOS AGDf1ESe/OR APHE 'I r i �.C'.I 1. •� `••C" F� C l G) "` CfEY G-':':.' i L- IAT ARE ONTIER'f NAME ( i(' 1' ADDREaa 4.....I i !`!-'1,:fr' PHONE CONTRACTOR �' f - } }--''1 t f i C'W t t _AODAMN Y-f i'f t- -2f + i v LICE PHONE:}` ,S C SUB CONTRACTOR - - ADDRESS ucf P wf TTFE OF SETTIC WORK: NEW INaTAlUT10N E3 REPAfMfAO01TtO1f Cr OP/TAVC710N 13 IND SEPTIC SYSTEM PERIAMED R PUNLIC fEWER IS AVAILABLE W"M 200 FEET OF eUIURN0.1 •R POW TESTW i I MW MARY 2, } APPEufen E L_ VISTAUATION WNL 4BRIE: RESIDENCE E3' COMMERCIAL D OTHER NVRLSEU OF LMNO UMTS; NUMBER OF NEDROOMi: NUMM OF EMPWTtU: CHARALTER OF E04 TO A OEM Of Se FEET: PITMUMP 90%.CHARACYER: WATER TASTE DEPt4 TJVa aE►no tANKRt• TRAP CITYPFMFO CAPACITY HO.COMPARTMEMS FRO TREATMENT PLANT© 014TANCE TO REARNT! WELL FOUNOATON FNOPERTY UNE RIFT STATION D SIZE TYPE OF PUMP BAND OIL SEPARATOR IENC OSE)SYSTEM) LfACMNIO UNE 13 NO.S LENGTH OF IME) DISTANCE TO N&NiFeT:YVO.L FOUNDATION PROPERTY LME RLTER oto D MOTH Loom PFPTH ORSTANCE TO NFAREfT-.WML FOIODATIONN PROPEMY UNE {ROUNDED ❑LNOTN LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATKTN PROPERTY LINE I OMPA02 PT4 13 DEPTH at;E NVMeEP DIfrANCE TO NEAREOTt WELL FOUNOATTOM PROPERTY INE -- awss ryO VM"R LENOTN btvrtt ORSrAMM TO NEAREST:WELL FOLUMTIDN PROPERTY tDfE OISMOAL PONDS CI WtDTN LENGTH DEPTH.-_.-� DISTANCE TO NEAREST:WELL FOVPWATI" FFKH"TY UNE fREIE&V CERTIFY THAT.1 HAVE PREPARED THIS APLICATWN AND THAT THE WOFK 1MLLIWOWM IN ACCORDANCE WTHAM JOAOVIN.Cq.11NTy_01161HANCES NEN STATE LAWS,AND RULES AND REquLATNOHS Of"*SAN JOAOUM CO V WY.NOME OWNERRoRLJCEHsm AOENt'S maNATURE COMF1E6 THE FOUDWINIh•ICOMFYTHAT INTHE PERFOIMANCI OF THE WORK PORVMCH TWO PFRAIT R am=,I•IML NOT EMPLOY ANY PERSON M SACH A MANNER AS To BECOMi SUBJECT TO WWKMAN'S COMPENSATION LAWS OF CAUPONRA.•CONTAACTORY NSENO OR fU"pNT;R4CTMO•)NATURE CERTIFIES THE FOLLOWMU:'t CERTIFY THAT M THE PEWOAAIANCE OF THE WORK FOR WMCN THIO KRIOT IS ISSUED,1 WtALL EMPLOY PERSONS SUBJECT TO NOIKMAi'S COTAF@RSATIONN LxWs OF/C�AUFOORMA.' THE APPLICANT MUTT CALL 2a NDTNia IS ADVANC[MRR ALL REOLORfD HISPOTIONS.COMRA7E ORAWINO SHOW. FEIOI®x.� ! rfl ".:7MsL-Sf'V �'� __.___ Tf,,.E:;.,i•RTTQ ��t,� ;F _ _DATE: 1!-I 3F J PLOT RAN CRAW TO SCAM SCALE 'Ro - 1_NAW-0 4-OTHEET4 OR ROADS NIEAMOr TO ORJIOlANOMq TIRE FROI'ERTY. a.LOCATION OF NDIME SEWAOS EEEQBAL:SYSTEM OR PPOPOSED 7-OVTLINIE111f,`Ttll FIIOPEItTY.VMH DILIEN•pNR AND NORM OMWTION:-. k7vAJISION OF fEWAOE'Q1fPDfK-1YRZa16 --. 2 FIEDOYTLIRES AM LOCATION.0*AJJ.MOT WO AND PROPOSED STRUCTURES. E.LOCATION OF WNL!YNE iRiii*4OP Humoom i rt DN - I:OVFREP'RTIF.AS SIICPI AS PATNOf.pNIVEWAYS;ARID WAIXS.' THE411 POP'FIRTY OR ADJDSRIO P110FfR[y- 3 L 1 { 2 i s 5 yT 3 r k ,...._;...._ ; 62 *14 41� P ...- 13 t f✓K y rq-I I � • 5 ~6 7S2 S 9 lU T 1 to •' • • ISA VE • ' :. ...a.....:............ . I % FOR DEPARTMENT DEE ONLY �f APPLICATION ACCEPTED eV )ATE: ��) rl-2OCe.) AREA: "-19 [''�•I TAMC,PIT OR SUMP ASPECT_ION OY.!r I I _ _PATE--L—j—FINAL INTPFCmw SV DATE i.+.. F ADbiT10NAl COMIAIEM4• �,—„ {yfr� AGCOUNNNO OMLY: AR]F FACE F I PC CODE FH INFO AMOURRT P2ARtTEO CTiECIV "AIH REC@VED ST PATE SR 7PHSUBT N� INVOICE f mAo Pub.FiaaRIl$esv.•E:mlrq.l7<[3!'98y i