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a SAN JOACIIiN COf1NTY Pf1Al1C HEALTH SERVICES <br /> k ENVIRONMENTAL HEALTH DIVISION <br /> ! P,O.BOX 388,304 FAST WEBER AVENUE,STOCKTON,CA 95201388 <br /> (2091469-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IC:mplots In Ti1gNFALA4 <br /> APPLicATiON IS HEREBY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT 70 CONSTRUCT ANDIOR INSTAU.THE 14ORK DESCmBEO.THIS APPLICATION IS MADE IN COMPLIANCE WITH BAN <br /> Z JOADUIN COUNTY DEVELOPMENT TITLE,CHAPTFR 9-1110.3 ANO THE S7ANDARDB OF SAN!JOAVAN COUNTY RmUc HEALTH SERVICES,ENVIRONMENTAL HEALTH DPASIOH. <br /> J08 AODRERR/OR APN/ // ..!`i1 �� clTv �1�.y LOT SIZEri �y <br /> O—II'S NAME I2C�� 12 1) 15(=-_7fL/r App R7:ss �tl. — PtwNE <br /> ��JJ <br /> f �y _ <br /> CONTRACTOR '4,�1 /^-I/I!_ !'-' AppRFSG LIC/ .�� RHONE <br /> SUB CONTRACTOR ADDRESS UC- PHCNE II <br /> TYPE OF 11"IC WORK: NEW W.11,LLAT1oN Q REPAIMADDIT1011,X nOT IUCTFON❑ 1 <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILARLE WITHIN TOU FEET OF SU:.UING.I PFFI TFs1I\I I I HOW MANY Il <br /> F KY _ APdlo.�:on <br /> INSTALLATION W U.AERVE: RESIDENCE E] COMMERCIAL❑ OTHFN <br /> NUMBER OF UVINO VNITI: — NUMBER OF BEDROOM&: NUMBER OF EMPLOYEES: <br /> [HARAGTER OF SOIL TD A DEPTH OF��ffEET: G` / piTfSUNP SOIL CHARAC7El1: J WATER TABLE DFFTN�CJ <br /> iSEPTIC'AkK/OREAAE TRA--PL_f!7YPEIMFO 1� CAPACT' L_ u�) NO.COMPAHTAtENTB <br /> PKO TRCATMCNT PLANT Q DISTANCE TO NEAIICST: WELL 7— FOUNDATIDM r� FROI'ER'FY LINE'y2_ -�T� <br /> IIFT STATION SIZE TYPE OF PUMP / SAND OIL 6E1'ARA7nR IENCLD6ED sYSTEMI _ <br /> 1 LEAGMNQ NNE �NO.A LEh'DTH OF LINEg /C_ DISTANCE TO NEAR£eT:WEIL F�7—IOUNDATION ]f PROPERiy LINE ' <br /> FIL7EA RFD R WIDTH IENOTH bEFTH DISTANCE TO NEAREST:S"ffLt. FOUNDATION PROPERTY LINE �f I <br /> MOUNDED Q WIDTH LENOTH UCPTH ilI5TA11CF TO NEAREST:WELL FOUNDATION PROPEflTY UNE T <br /> SEEPAGE MTE �L-JI DEPTH SSZE _ NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROE'ERTY LINE <br /> SHIPS LJ WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WEii FOUNDATION PROPERTY LINE <br /> F11111POIAL PONOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPUCAT}ON AND THAT THE WORK WILL RE PONE IN ACCORDANCE WITH SAN JDAOUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> AND REGULATION:OF THE SAN JOACUIN COUNTY.HOME OWNER ORUCENBED AOENY'S SIGNATURE CERTIFIES THE FOLLOWIN'O:'I CERTIFY THATIN TFIEPENFORMANCE OP THE WORK FOR WHICH <br /> TW8 PERMIT IB ISSUED,L S4 LL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENEATION LAWS OF CALIFORNIA.- CONTRACTOfl'e HIR$NG OR <br /> SUB.COFTTRACTINC SIGNATURE CERTIFIERTHE FOLLONRNO:I CERTIFY'14AT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUEO.1$HALL EMPLOY PERSONS SUBJECT TO <br />"rCALIFORNIA.' <br /> WOWMAN'S COMPENSATION LAWS OF CALIFORLBIA THE APPLICANT MUST FALL xA ROIN ADVANCE FOR ALL REWARFD INSPECTION$. COMPLETE DRAWING BELOW. <br /> SIGNED f .! y (7 /7 <br /> I <br /> PLOT FLAN IORAW TO SCALE)SCALE -To I <br />[—I <br /> '''�T.NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. 4.LocA7{oN OF HOUSE sfwAOE DISPOSAL EYBTEM OR PROPOBEO I <br />= 12. OIRUNE OF THE PROPERTY,WITH OIMENSLONB AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL BYBTFMB, ` <br /> E 7. DIMEN:IONEO OUTLINES AND L.OAT50N OF ALL EXISTING AND PTO PC CID STRUCTURES, 6.LOCATION OF WELLS NRTHIN RADIUS OF ONE HUNDRED FIFTY Ff.ON <br /> INCLUDMO COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALLS. THE PROPERTY OA ADJOINING PRCPEPTY, <br /> 7. _ <br /> s h <br /> 13 I <br /> G <br /> l <br /> .... -......E... .... .. .1 <br /> 1 <br /> 1 '. <br /> v <br /> i <br /> € IFi, <br /> :.,SEP2 6 193. <br /> 97 <br /> ONtv1ENTAl_;IHFA k UlVISIUN . <br /> ....i. ........ ... ..i...... . ... .. :.. .f .. <br /> ..... .... E.NVkA <br /> . . .,. .. ......... <br /> ... . ;'.E. <br /> j FOR DEPAATMENT USE ONLY <br /> /\I �1.'l.i S:.'}--+.-, DATE 1 " _ — API .7J"rPPLTC4TIONA�C�PTEDDY <br /> ANK,TNT OR SUMP INSPECTION BVI_ _ DATE 1 / FINAL INSPECTION BY `�.>n'L��-'�L1_0,4 ') PATE (j 11, <br /> L <br /> ADDLTIONAL COMMENTS: <br /> AO COUNTIHD OF1LY: AID: FAG♦ <br />_PPE CODE FEE INFO AMOUNT REMF3'TED CHEC ICASN FECDVED OT PATE SR/PpiMIT NUM.. INVUICE a <br /> F <br /> 421 .N 1.1} `� l (� 7 DSI 1751 <br /> I _ <br /> - Pub.Heellh SeN.-Envilo.174(3/96) <br />