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y l SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 304 EAST WEBER-AVENUE, STOCKTON, CA 95201-388 <br /> {209} 486-3420 ��� <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 01sc <br /> ICompleta ilt TTIPlicsto) <br /> LICATION IS HEREBY MADE TO THE BAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IB MADE IN COMPLIANCE WITH SAN <br /> 01.1IN COUNTY DEVELOPMENT TITLE,CHAPTER$-1110.3 AND THE STANDARDS OF SAN JOAQU N CO NTY PUBLIC HEALTH SERVICES,ENVIRCINMENTAL HEALTH DIVISION. <br /> I ADDRESSIOR APN# I I7 9- CITY LOT SIZE - <br /> HEI'ViNAME `ADDRESS <br /> PTiONE I <br /> YT <br /> RAC70q - ADDRESS LIC# _ ONE <br /> I CONTRACTOR ADDRESS - .UC# PHONE <br />'E OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRJADOITION DESTRUCTION❑ <br /> SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.1 PFAC TESTINI 1 1 HOW MANY <br /> Applloetlon 0 <br /> TALLATION WILL SERVE: RESIDENCE COMMERCIAL ❑ OTHER <br /> VABER OF LIVING UNITS: NUMBEIR OF BEDROOMNUMBER OF EMPLOYEES: <br /> : ✓ <br /> UTACTER OF SOIL TO A DEPTH OF 3 FEET + PITISUMP SOIL CHARACTER; WATER TABLE DEPTH <br /> TIC TANKIGREASE TRAP ©TYPFJMFG CAPACITY NO,COMPARTMENTS <br /> I TREATMENT PLANT 0 DISTANCE TO NEAREST: WELL.__�Q gq I FOUNDATION ��...,� PROPERTY LINE�� <br /> LIFT STATION❑ SIZE TYPE OF PUMP <br /> ! SAND OIL SEPARATOR IENCLOSED SYSTEM) t / <br /> CHINO LINE 11 NO.&LENGTH OF LINES__'�•� � _ DISTANCE TO NEAREST:WELL O FOUNDATION-„_PROPERTY LINE v <br /> ER BED ❑WIDTH - .,LENGTH DEPTH DISTANCE TO NEAREST:WELL .� FOUNDATION PROPERTY LINE <br /> UNDER ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FgUNOATION PROPERTY LINE <br /> l <br /> PAGE PITS 11 DEPTH SIZE------------- <br /> _ ] Iy[ NUM$Eq DISTANCE TO NEAREST;WELL FOUNDATION PROPERTY UNE <br /> 1� WIDTHvor LENGTH 1 ( /► DEPTH DISTANCE 70 NEAREST:WELL m FOUNDATION��PROPERTY UNE <br /> 1OSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> REBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> IREGULATIONS OFTHE SAN JOAQUINCOUNTY.HOME OVMERORUCENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:*1 CERTIFYTHAT IN THE PERFORMANCE OF THEWOW FORWHtCH <br /> I PERMIT IS ISSUED,.I SHAD.NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA," CON7RACTOR'B HIRING OR <br />-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WMAN'S COMPENSATION LAWS OF CALIFORNIA,` THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS, COMPLETE DRAWING BELOW. <br /> I 7 <br /> IED X TITLE: arld DATE: <br /> PLOT PLAN(DRAW TO SCALE)SCALE •to <br /> TAMES OF STREETS OR ROADS NEAREST Tq OR BOUNDING THE PROPERTY. 4, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEMPROPOSED <br /> WTUNE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> IIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> ICLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> .. -_- ... <br /> --- . -- .. <br /> rJ <br /> F <br /> �. <br /> zz <br /> 6�C QGUlAJ GuUrr7' <br /> E1aVi OlYhrfENTAt NEAiI'ivicV <br /> S!U!� <br /> . <br /> :.. _ <br /> :.... <br /> :.............:............:. ..;,.....:.. s :. . <br /> .... --..,. .. . <br /> _ %14 ., .. <br /> 4D � �4 <br /> f � <br /> E <br /> D <br /> FOR DEPARTMENT USE ONLY �//j 7 <br /> CATION ACCEPTED BY / ATE ` /C <br /> .O _t - <br /> � <br /> K.IP,fT,OR8UMPTTI_ CTIOHBK,�•+'�:.� �',��.. - ' DA y�y' "-. F`FINALTINePECT1OH elf '• b,..,,, ?3 �""• -' ', .. ' <br /> 4('�k�� "''"a41'�"•4N.+.�'!��.�'^�.z gli..q, 'k±ltc.- - <br />