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JOAQUINo7iNTt rusri`c LrtaLtirs'iRVlci€s�`-may+ C��O 7S `j ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA%201.388 (2091468-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (Complete In TFglleatal APP ATION 18 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOW DESCRIBED. THIS APPLICATION IB MADE IN COMPLIANCE WITH BAN "AMIN COUNTY DEVELOPMENT TITLE,CHAPTER B-1110.3 AND THE STANDARDS OF SM JOAQUIN COUNTY PUBLIC HEALTH SE//RVICEB,ENVVIIRONMEMAL HEALTH DIVISION. JOB ADDRESSOR APNF zlcx � FiQE�e2T �P5 CITY /�il�/T/�/�ITnLOT SIZE_ OWNER'9NAME ADDRESS_ PHONE CONTRACTOR '^— /L K/ /�� L� �_AODRE68 ,Or .eUr6�7 LIC( SUB CONTRACTOR ADDRESS UC# PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION r REPAIR/ADDITION ❑ DESTRUCTION ❑ INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 19 AVAILABLE WITHIN 200 FEET OF BUILDING I PAID TEBTI.l 1 I HOW MANY 0.Y APPIImBon f 15 INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL ❑^� OTHER ❑ NUMBER OF"NO UNITS:_ NUMBER OF BEDROOMS: V NUMBER OF BMKOYEE�E�Sr:��wO- CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: Z, /J WATER TABLE DEPTH SEPTIC TANXIORLA6E TRAP ❑iVPE/MFO �/ CAPACITY OS1=[/e)_ W.COMPARFMENTS [X PXO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL�/Jlj/FT FOUNDATION OFT PRDPEREY LINEy ��T LIFT STATION❑ SSIZE TYPE OF PUMP GSAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACHING LINE p NO.a LENGTH OF LINES_ r DISTANCE TO NEAREST: PROPERTY UNE RLTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE n SEEPAGE Pit ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE l+ BUMPS �WIDTN LENGTH —DEPTHza/ DISTANCE TO NEAREST:WELV POUNDATION PROPERTY LANE O DISPOSAL PONDS ❑MOT" LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE O 1 HEREBY 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 AND REGULATIONS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOMIING:•1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT la ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR 71 SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:•I CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PENArt 98 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPETE DRAWING BELOW. �m1 yw III SIGNED% � N/'�� TITLE: DATE:/ ��— f2 MOT PUN IDMW TO SCALE]SCALE •RP 1. NAMES OF STREETS OR WADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 9. DIMENSIONED OUTUNEB AND LOCATION OF ALL EXISTING AND WOMBED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS.DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. tGc(iriTED 'SAD 14C- 7c /[ w — 7L' TG+2s 3 tae D .. e4l41Q PAYMENT t SEP 9 1997 PURI SAN 70AQUTAI COUNTY /FOR DDUM MENTYt[ONLY ^'� APPLICATION ACCEPTED BY �M/VLi\Jr {r 4�_ } DATE: �'� AREA: a-.P I TANK,AT OR SUMP INSPECTION BY _J� DATE ( / FINAL INSPECTIONRyD Da ,- q DATE / I ?l ADDITIONAL COMMENTS:_ u-I Rl A ACCOUNTNO ONLY: AIDE FAC# PE CODE FEE INFO AMOUNT RFMII TED CHECIIABH RECOVEO BV DATE 6R I PERMIT NUMBER INVOICE f L� im4l-�D L6 9/a3/ O �; o�ilp9 Pub.Health SeN -Enviro. 174(3/96)